The mitral valve opens during diastole allowing the motion of the blood from the left atrium to the left ventricle (See transesophageal echocardiography below). During diastole, the large opening of the anterior mitral leaflet divides the left ventricle into two distinct functional areas namely the inflow chamber and the outflow tract (See mid esophageal long axis view). The final position of the anterior and posterior leaflets during diastole determines the size of the inflow chamber.

During systole, the mitral valve is in closed position with a large surface of coaptation between the anterior and posterior leaflets preventing blood regurgitation from the left ventricle into the left atrium (See transesophageal echocardiography below). Three distinct types of mitral annular motions are described and consist of apical displacement, circumferential contraction, and a folding motion in intercommissural axis. Systolic ventricular contraction results in a shortening of left ventricular longitudinal axis drawing the mitral annulus towards the apex. This modification in the left ventricular configuration and size displaces a column of blood which is ejected into the aorta. In systole, the anterior mitral leaflet and the interventricular septum limit the outflow chamber through which the blood is directed from the left ventricle towards the aorta (See mid esophageal long axis view).

Mid esophageal four-chamber view

Mid esophageal mitral commissural view

Normal 3D TEE

Mid esophageal two-chamber view

Mid esophageal long axis view