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Figure 2 A, Measurement of the leaflet excursion angle on the apical four-chamber view. The angle between the base of the anterior mitral leaflet (its tangent line) and the mitral annular line at end-systole is ₁ and at maximal diastolic opening is ₂. The leaflet excursion angle . LV, left ventricle; LA, left atrium. B, Method of assessing the diastolic alignment. The angle of maximal leaflet opening (₂) is compared to that between the annular line and the line connecting the attachments of the anterior leaflet at the anterior annulus and lateral papillary muscle tip (PM angle). The patient is considered to have diastolic alignment if the difference between these angles is <5°. The upper panel shows a normal control, the lower, a patient with diastolic alignment in the IMLC group.