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Fig. 4A —13-year-old girl presenting with dyspnea on exertion who had undergone extracardiac Fontan operation for tricuspid atresia. Axial steady-state free precession cine MR image of heart shows extracardiac Fontan circulation (arrow) to bypass hypoplastic right ventricle; ventricular septal defect; and small signal void (arrowhead) extending from mitral valve into left atrium in systole, corresponding to mitral valve regurgitation.