Figure 5
Tricuspid annular tissue Doppler imaging pre cardioversion showing two extra velocities, one with smaller amplitude preceding and one with larger amplitude following annular e’ wave, both immediately following the flutter P wave on the ECG prior to cardioversion (A). These waves disappeared during sinus rhythm after cardioversion (B). These velocities were almost unrecognizable on mitral inferolateral annular Doppler pre cardioversion (C) and normal tissue Doppler mitral annular pattern emergent post cardioversion (D). Restrictive appearing mitral inflow pattern (E) and increased TR peak velocity of3.1 m/sec corresponding to a pressure gradient of 38 mm Hg is shown (F). Due to Doppler beam insonation angle of 60 degrees with the tricuspid annulus there is Doppler signal noise most marked in A.