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Figure 2 Lack of important incomplete mitral leaflet closure (IMLC) and mitral regurgitation (MR) in a patient with lone atrial fibrillation (AF), despite annular dilation (yellow arrows), compared with a patient with idiopathic or ischemic cardiomyopathy (ICM) showing moderate IMLC and MR. Longer papillary muscle tethering length (white arrows) in the patient with ICM restricts leaflet closure and induces IMLC and MR.