Rheumatic MS

Degenerative MS

Congenital MS

The main lesion is “commissural fusion”

The main lesion is “annular calcification”. No commissural fusion

The main lesion is in “subvalvular apparatus”. Commissural fusion is rare

Calcification predominates at leaflet tips

At base of leaflets

Chordal fusion with calcification

Planimetry is reliable

Not reliable

Large orifice may be present

Pressure half-time reliable

Unreliable due to impaired diastolic function and should be avoided

Reliable when diastolic jet occurs

Mean Gradient can be used following balloon mitral commissurotomy

Mean Gradient can be used as a marker of severity

Reliable when diastolic jet occurs

Central or commissural jet due to valve stiffness.

No particular orientation

Central jet in symmetric type. Eccentric jet in asymmetric type (anteriorily oriented jet in parachute type)

Orifice is circular or elliptical in short axis view of planimetry.


Chordal convergence’ on a single papillary muscle in short axis view at mid-ventricular level in parachute type

Manifest in younger age group

Manifest in older age group

Seen from birth

Single orifice

Single orifice

May present with “double orifice” type