Two-dimensional TTE examination and intra-operative inspection of the mitral valve in patient 3. (A) Parasternal long-axis view, systolic. (B) Apical four-chamber view, systolic. Morphologic examination of the mitral valve leaflets in both views revealed several structural abnormalities, such as leaflet thickening and vegetations on the edges of both leaflets. (C) Severe MR as determined by jet area (13.4 mm2) divided by left atrial area (25.9 mm2) (= 52%) and the vena contracta width (= 6 mm, not shown). (D) Superior view of the excised posterior mitral valve leaflet (as seen from the left atrium). (E) Frontal view of the excised posterior mitral valve leaflet. Both views show marked thickening and calcification of the posterior mitral valve leaflet and several thrombotic vegetations on the edge of the leaflet. Ao: aorta, LA: left atrium, LV: left ventricle, MR: mitral regurgitation and V: vegetations.