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Figure 4 Diagram of a midsystolic tented mitral leaflet geometry (left top) with a typical leaflet contour imaged by two-dimensional echo from the apical view (below). Left ventricular side in z direction. The occlusional leaflet area, OLA, was calculated as the sum of fractions of a cone produced from four apical scanning planes rotated around an axis through the midpoint of the annulus (right top; one fraction of a cone is marked). Notice leaflet edge separation due to leaflet asynergy creating a regurgitant orifice. Variables to describe leaflet configuration are illustrated (r and h). The intersection of the anterior leaflet extension on the posterior leaflet gives the horizontal length r₄ and perpendicular distance h₄ of the posterior leaflet involved in mitral orifice occlusion. _AL and _PL = systolic leaflet coaptation angle of the anterior and posterior leaflet; D_AL, D_PL = perpendicular distance from anterior and posterior leaflet tip to the annular plane; L_AL, L_PL = horizontally projected lengths of the anterior and posterior leaflet.