{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T19:38:21Z","timestamp":1772653101169,"version":"3.50.1"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Apical aneurysms are a recognized complication of hypertrophic cardiomyopathy (HCM), reported in up to 30% of cases with apical and mid-ventricular involvement. They carry significant arrhythmic and thrombo-embolic risk, but the spectrum of associated intracavitary flow abnormalities is not fully described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>An 86-year-old woman presented with ventricular tachycardia, successfully cardioverted to sinus rhythm. Echocardiography demonstrated preserved ejection fraction with severe mid-ventricular and apical hypertrophy, and a large apical aneurysm (5\u2005cm) confirmed on contrast echocardiography without thrombus. Global longitudinal strain was reduced (\u22125.6%). Cardiac magnetic resonance revealed mid-cavity hypertrophy and aneurysm formation, with patchy late gadolinium enhancement at the right ventricular septal insertion site, predominantly in the basal and mid-anteroseptal walls. Doppler interrogation identified a novel bifid systolic jet directed into the aneurysm during isovolumic contraction, as well as a paradoxical early diastolic jet from apex to base. Colour Doppler showed swirling intra-aneurysmal flow with a Yin\u2013Yang appearance. The patient was stabilized on antiarrhythmics and advised implantable cardioverter-defibrillator therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>While paradoxical diastolic flow has been previously described in HCM with mid-ventricular obstruction, paradoxical bifid systolic jets have rarely been reported. These findings likely reflect transient pressure gradients between the contracting ventricle and the compliant aneurysm. The Yin\u2013Yang Doppler pattern, more commonly associated with pseudoaneurysms, here reflected abnormal haemodynamics within a true aneurysm. This case highlights the importance of multimodality imaging not only for structural characterization and thrombus exclusion but also for identifying atypical intracavitary flow dynamics that may expand understanding of HCM pathophysiology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag108","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T12:43:47Z","timestamp":1770295427000},"source":"Crossref","is-referenced-by-count":0,"title":["Unusual flow patterns in a left ventricular aneurysm in hypertrophic cardiomyopathy: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0389-9926","authenticated-orcid":false,"given":"Salman","family":"Salahuddin","sequence":"first","affiliation":[{"name":"Department of Cardiology, Aster MIMS Hospital , Mini Bypass Road, Govindapuram, Kerala, Calicut 673016 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bijoy","family":"Karunakaran","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Aster MIMS Hospital , Mini Bypass Road, Govindapuram, Kerala, Calicut 673016 ,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"2026030413313037900_ytag108-B1","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.jacc.2016.11.063","article-title":"Hypertrophic cardiomyopathy with left ventricular apical Aneurysm: implications for risk stratification and management","volume":"69","author":"Rowin","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2026030413313037900_ytag108-B2","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1093\/ehjci\/jev192","article-title":"Differences in apical and non-apical types of hypertrophic cardiomyopathy: a prospective analysis of clinical, echocardiographic, and cardiac magnetic resonance findings and outcome from 350 patients","volume":"17","author":"Kim","year":"2016","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026030413313037900_ytag108-B3","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1161\/CIRCULATIONAHA.108.781401","article-title":"Prevalence, clinical significance, and natural history of left ventricular apical aneurysms in hypertrophic cardiomyopathy","volume":"118","author":"Maron","year":"2008","journal-title":"Circulation"},{"key":"2026030413313037900_ytag108-B4","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.ijcard.2016.07.154","article-title":"Apical hypertrophic cardiomyopathy: present status","volume":"222","author":"Jan","year":"2016","journal-title":"Int J Cardiol"},{"key":"2026030413313037900_ytag108-B5","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1007\/s00392-023-02328-8","article-title":"Apical hypertrophic cardiomyopathy: pathophysiology, diagnosis and management","volume":"113","author":"Li","year":"2024","journal-title":"Clin Res Cardiol"},{"key":"2026030413313037900_ytag108-B6","doi-asserted-by":"crossref","first-page":"e015555","DOI":"10.1161\/CIRCIMAGING.123.015555","article-title":"Apical aneurysm development in hypertrophic cardiomyopathy","volume":"16","author":"Habib","year":"2023","journal-title":"Circ Cardiovasc Imaging"},{"key":"2026030413313037900_ytag108-B7","doi-asserted-by":"crossref","first-page":"e672","DOI":"10.5114\/pjr.2021.112310","article-title":"Cardiac magnetic resonance in the assessment of hypertrophic cardiomyopathy phenotypes and stages - pictorial review","volume":"86","author":"Stachera","year":"2021","journal-title":"Pol J Radiol"},{"key":"2026030413313037900_ytag108-B8","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1148\/rg.2016150137","article-title":"Hypertrophic cardiomyopathy from A to Z: genetics, pathophysiology, imaging, and management","volume":"36","author":"Baxi","year":"2016","journal-title":"Radiographics"},{"key":"2026030413313037900_ytag108-B9","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.jcmg.2022.11.013","article-title":"Apical aneurysms and mid-left ventricular obstruction in hypertrophic cardiomyopathy","volume":"16","author":"Sherrid","year":"2023","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026030413313037900_ytag108-B10","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1016\/0002-8703(88)90730-2","article-title":"Mid-cavity obstruction in apical hypertrophy: Doppler evidence of diastolic intraventricular gradient with higher apical pressure","volume":"116","author":"Zoghbi","year":"1988","journal-title":"Am Heart J"},{"key":"2026030413313037900_ytag108-B11","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/j.echo.2011.03.002","article-title":"Apical hypertrophic cardiomyopathy: prevalence and correlates of apical outpouching","volume":"24","author":"Binder","year":"2011","journal-title":"J Am Soc Echocardiogr"},{"key":"2026030413313037900_ytag108-B12","first-page":"314","article-title":"Paradoxical systolic and diastolic flow abnormalities in hypertrophic cardiomyopathy with mid-cavity systolic obstruction","volume":"18","author":"Luckie","year":"2011","journal-title":"Cardiol J"}],"container-title":["European Heart Journal - 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