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Figure 1. A 47-year-old woman presented with fatigue and worsening exertional dyspnea. Cardiac auscultation was remarkable for an irregularly irregular rhythm, a loud S1 and accentuated P2, an opening snap, and a III/IV decrescendo diastolic rumble at the apex. Transthoracic echocardiography revealed findings typical of rheumatic mitral stenosis. The mitral leaflets were pliable, with restricted mobility of the leaflet tips (open arrow, panel A), resulting in doming and a "hockey-stick" appearance of the anterior leaflet in diastole (solid arrow, panel A). There was no notable subvalvular thickening. Cross-sectional imaging of the stenotic orifice (Panel B) demonstrated thickening restricted . . . [Full Text of this Article] |