Atrioventricular septal defect with two valve orifices. (A) Internal view of the left ventricle showing obstruction of the outflow tract by invasion of the left anterior leaflet of the left atrioventricular valve (dotted lines and double headed arrow). The asterisk indicates the commissure between the septal anterior and posterior leaflets. (B) The parasternal long axis echocardiographic image shows similar features (arrow). Abbreviations: PL: Posterior leaflet. Other abbreviations as before.