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. Author manuscript; available in PMC: 2010 Jul 28.
Published in final edited form as: Circulation. 2009 Jul 13;120(4):334–342. doi: 10.1161/CIRCULATIONAHA.108.846782

Figure 1.

Figure 1

Normal MV closure (A,C); effect of apical and posterior shift of PMs restraining the MV, causing MV leaflet tethering (D) and, if severe enough, MR (B). Lower panel (C & D): Echocardiography of the LV (apical two-chamber view) in the same sheep prior to (C) and after pulling the PMs apically resulting in MV leaflet tethering (D). The dashed line indicates the mitral annular level. (Ao: Aorta, LA: left atrium; LV: left ventricle, MR: mitral regurgitation; MV: mitral valve; PM: papillary muscle) (Figures A & B adapted from Levine et al 14).