Figure 33-10 Systematic examination of the mitral valve. In this examination, the mitral valve is viewed in multiple cross sections to delineate leaflet anatomy. The "5-chamber" cross section is accomplished by withdrawing the probe slightly from the standard 4-chamber cross section until the left ventricular outflow track is in view. The center column shows the planes of the different cross sections as viewed from directly above the base of the heart. The 2-chamber "anterior," "mid," and "posterior" cross sections are variations of the standard 2-chamber cross section and are accomplished by turning the probe from the patient's right to left. "P1, P2, and P3" refer to the three scallops of the posterior mitral leaflet, and "A1, A2, and A3" refer to the juxtaposed segments of the anterior mitral leaflet. The right column shows the leaflet segments seen in the corresponding cross section. (Redrawn from Lambert AS, Miller JP, Foster E, et al: Improved evaluation of the location and mechanism of mitral valve regurgitation with a systematic transesophageal echocardiography examination. Anesth Analg 88:1205–1212, 1999.)