3D echocardiography showing increase in systolic anterior motion and LVOTO with increased mitral leaflet area. a,b | Component view from a healthy control individual with diastolic leaflet traces for 3D reconstruction. c–e | Representative open mitral leaflet area measurements in green and purple for anterior and posterior leaflets viewed from the side. Top row: lateral commissure in foreground. Bottom row: left ventricular outflow tract aspect. Smallest values are seen in healthy controls (c), intermediate values with ASH and no resting LVOTO (d), and greatest leaflet areas in patients with ASH and resting LVOTO (e). Abbreviations: Ao, aorta; ASH, asymmetrical septal hypertrophy; LA, left atrium; LV, left ventricle; LVOTO, left ventricular outflow tract obstruction. Reprinted from Kim, D. H. et al. In vivo measurement of mitral leaflet surface area and subvalvular geometry in patients with asymmetrical septal hypertrophy: insights into the mechanism of outflow tract obstruction. Circulation
122 (13), 1298–1307 (2010).