Two-dimensional TTE examination and intra-operative inspection of the mitral valve in patient 4. Morphologic examination of the mitral valve in both views revealed a 0.8 × 1.0 cm tumor on the posterior mitral valve leaflet; (A) Parasternal long-axis view, mid-diastolic; (B) Apical four-chamber view, end-diastolic. (C) Mild-to-moderate MR as determined with colour-Doppler TTE; apical four-chamber view, systolic. (D) Intra-operative inspection of the mitral valve (transseptal approach): a verrucous thrombotic tumor was found on the P2 section of the posterior mitral valve leaflet. (E) The verrucous thrombotic tumor was removed with a quadrangular resection of P2. Ao: aorta, LA: left atrium, LV: left ventricle, MR: mitral regurgitation and T: tumor.