“…(15) Annular flattening, expressed as height relative to dimension within the average plane, might simply be secondary to annular dilatation, but in the current study FED and DMD patients interestingly had similar ventricular and atrial remodeling. (9) Annular flattening also exerts increased out-of-plane tension on the annulus, leaflets, and chords, which can elongate biomechanically weakened leaflets, promoting prolapse and increasing the likelihood of chordal rupture. (16) In patients with MVP and no or mild MR, annular flattening likely might suggest primary annular pathology in DMD.…”