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Figure 4: (a) In the normal heart, the lateral tethering angle at end systole is approximately 90º which allows optimal coaptation of the valve leaflets. (b) In hypoplastic left heart syndrome (HLHS) with mild tricuspid valve insufficiency (TVI), the lateral tethering angle is approximately 100º which tethers the anterior/posterior leaflets more medially optimizing leaflet coaptation. (c) In HLHS and severe TVI, the lateral tethering angle is approximately 90º or less pulling anterior/posterior leaflets away from the septal leaflet

Figure 4: (a) In the normal heart, the lateral tethering angle at end systole is approximately 90º which allows optimal coaptation of the valve leaflets. (b) In hypoplastic left heart syndrome (HLHS) with mild tricuspid valve insufficiency (TVI), the lateral tethering angle is approximately 100º which tethers the anterior/posterior leaflets more medially optimizing leaflet coaptation. (c) In HLHS and severe TVI, the lateral tethering angle is approximately 90º or less pulling anterior/posterior leaflets away from the septal leaflet