Fig. 1. Echocardiographic images of the mitral valve (midesophageal four-chamber view), showing characteristic features of rheumatic heart disease. (A ) Thickened and calcific mitral valve leaflets with mitral annular calcification. LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle. (B ) Color flow doppler shows turbulence of forward flow through the stenotic valve as well as severe regurgitation.