Haemodynamics of left ventricular apical pouch: is Doppler obstructing us from seeing the full story?

A 77-year-old woman underwent invasive haemodynamic evaluation 6 years after septal myectomy and bioprosthetic aortic valve replacement for hypertrophic obstructive cardiomyopathy and aortic valve stenosis. Echocardiography revealed a small, hyperdynamic left ventricle (LV) with an apical pouch (Panel D) but no residual dynamic outflow tract obstruction. The aortic prosthesis systolic mean gradient was 31 mmHg. Retrograde LV catheterization...