Fig. 2

Pre-operative transoesophageal echocardiogram (TOE) was performed to assess valve function and assess for vegetations. TOE showed the posterior leaflet of the previously repaired mitral valve to significantly shortened and thickened but no clear signs of infective endocarditis. Superimposed Doppler assessment demonstrates severe mitral regurgitation and the 3-dimensional (3D) re-construction demonstrates the restriction of the valve, both secondary to this shortened and thickened posterior leaflet