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Copyright © 2001 Paolo Barbier

The separation is measured as the distance between the E point of the mitral valve and the corresponding (synchronous) interventricular left septal endocardium (vertical arrow). Normal value < 6 mm
(Massie 1977; D'Cruz 1979)

Distance between white dots = 10 mm 

Mitral valve B-bump

Delayed closure of mitral leaflets between the A and C (leaflet coaptation) points, determining a "notch" known as B-bump (small arrows). Indicates increased left ventricular end-diastolic pressure. 
(Konecke 1973)

Normal mitral valve morphology and dynamics are shown in the lower panel. 

Mitral valve E-septum separation

Left panel: mitral valve stenosis. 
Right panel: dilated cardiomyopathy

Mitral E-septum separation cannot be used when mitral valve motion is restricted by valve stenosis. In this setting, the measurement does not reflect left ventricular dilatation and systolic dysfunction.