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This is the aortic valve in closed position and mitral valve also appears to be closed in position. From the images you do not know whether the mitral valve is really fully closed or almost about to be closed. The VSD is partly overrided by the aorta. Separation between the attachments of the aortic and mitral valve.
We know a small ASD decompresses mitral stenosis, and the combination of ASD and MS, Lutembacher, is a well-known syndrome called Lutembacher. Curious minds might ask, can’t we decompress LV it self by creating a small VSD. The concept of LA flow regulator or decompressor came from this. Probably in the thin membranous area.
Documented reports in Ghana go back to 1964 with the use of surface cooling to close atrial septal defects (ASDs) and performing a closed mitral commissurotomy at the Korle-Bu Teaching Hospital in Accra, under Charles Easmon, general surgeon and head of the Surgery Department at the hospital.
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