Transesophageal echocardiography. (A) Persisting tethering of the second‐order chords (arrow) causing mitral valve repair failure after isolated mitral annuloplasty for ischemic mitral regurgitation; from Calafiore et al.,¹⁶ with permission. (B) Three‐dimensional reconstruction of the mitral valve and mitral leaflets. The anterior leaflet is attracted toward the apex due to further retraction of the second‐order chords (arrow) not cut at the time of the first repair procedure (same case as in Figure 3); from Calafiore et al.,¹⁷ with permission.

Transesophageal echocardiography. (A) Persisting tethering of the second‐order chords (arrow) causing mitral valve repair failure after isolated mitral annuloplasty for ischemic mitral regurgitation; from Calafiore et al.,¹⁶ with permission. (B) Three‐dimensional reconstruction of the mitral valve and mitral leaflets. The anterior leaflet is attracted toward the apex due to further retraction of the second‐order chords (arrow) not cut at the time of the first repair procedure (same case as in Figure 3); from Calafiore et al.,¹⁷ with permission.

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Based on Carpentier's classification and principles, the techniques for mitral valve repair continue to evolve. We herein report our experience with the morphofunctional echocardiographic analysis of single mitral leaflets, as different anatomic features, even if conflicting, may coexist not only in the two leaflets but in the same leaflet as well....

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