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Figure 2 Three-dimensional (3D) images of mitral annulus and leaflets in a normal subject. (A) Anatomical 3D image (views from two directions). Mitral annulus appeared as a nonplanar "saddle shape." Mitral leaflets appeared almost flat, with a little tethering into the left ventricle. (B) Actual 3D tenting image. The annular shape was approximated for the 3D quantitation. Mitral leaflet configuration was represented in contour to appreciate the degree of tenting in the vertical view from left ventricle (left). Horizontal view provides the degree of annulus nonplanarity and actual tenting of the leaflet (right). Black dots indicate coaptation line. Circumferences, area, and height of the mitral annulus were measured from these 3D data. (C) Corrected 3D tenting image. The curved mitral annulus was stretched on a flat plane, keeping the distance from the annular surface to the leaflet. Mitral leaflet tenting from the level of 3D mitral annulus was represented in contour in the vertical view from the left ventricle (LV) (left). Horizontal view provides the degree of tenting of the leaflet from the level of mitral annulus (right). Black dots indicate coaptation line. Maximum tenting length, mean tenting length and tenting volume were measured from these 3D data. A = anterior; P = posterior; CL = antero-lateral commissure; CM = postero-medial commissure; LA = left atrium.