The color Doppler continuous wave interrogation of the tricuspid annulus (Figure 4-5) (with a scan plane slightly lower – Figure 6 – than that used to visualize the coronary arteries, Figures 2-3) shows a high-velocity jet located at the medial tricuspid annulus with a systolic trans-valvular gradient= 130 mmHg. A diagnosis of severe pulmonary hypertension was made. However, at a closer inspection (Figure 5), the duration of the jet appeared to be systo-diastolic (white dashed arrow). Further, careful angulation of the continuous wave beam allowed to discriminate 2 distinct jets: the previously imaged high-velocity jet (Figure 7) and a second lower velocity jet (Figure 8), with a systolic pressure gradient= 23 mmHg.