A young man with precordial continuous murmur

A young man was admitted for recurrence of acute myeloblastic leukaemia. On examination, blood pressure was 120/78 mm Hg. Cardiac auscultation revealed a soft precordial continuous murmur with normal P2. ECG revealed non-specific intraventricular block. A transthoracic echocardiogram (TTE) demonstrated normal chamber size with mild global left ventricular hypokinesis (ejection fraction (EF) 52%). On apical four-chamber view with colour Doppler, low velocity flow was demonstrated across the interventricular septum (online supplemental video 1). Parasternal short-axis colour Doppler documented abnormal systolic retrograde flow (toward the transducer) into the main pulmonary artery (MPA). Pulse Doppler located just distal to the pulmonary valve revealed that both the systolic and diastolic blood flow were …