Fig. 9

Patient 3. A: There were two main diastolic vortices (1,2), triggered by the restrictive mitral inflow and intraventricular recirculation of flow. Both vortices rotated clockwise, generating a conflicting flow at the interface between them, with mid-LV stasis and increased recirculation in the apex (Additional file 11). (D); B: In systole, a part of the downwards-going flow converged into the mitral insufficiency jet, while the outflow tract displayed low-velocity flow (black arrow; E color Doppler); C: low-velocity LVOT flow (black arrow); F: LVOT PW Doppler confirms the low flow