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Figure 2 Upper panels: Apical two-dimensional echo images (LV on top, LA below the mitral valve, aorta at lower right) showing no mitral regurgitation (MR) at baseline (S1) and with left circumflex coronary artery (LCX) occlusion but pericardial restraint (S2) and moderate MR with the pericardium open (S3). Lower panels: Views of the 3D reconstructions from the apex, with the mitral annulus en face, the PM tips as yellow and green and the anterior annular reference point as red (Fig. 1F). With LCX ligation, the PMs, especially the ischemic medial one (green), migrate away from the annular reference, stretching the leaflets over a larger distance. This shift is mild with limited LV dilation (S1 to S2) and larger when geometric changes are permitted (S3, open pericardium). Other abbreviations as in Figure 1.
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