Severe Mitral Stenosis- The physical examination revealed a right parasternal heave, a loud S1, a midpeaking systolic ejection murmur (grade 2/6) at the upper sternal border, and a low-pitched diastolic rumble at the apex. An electrocardiogram showed atrial flutter with variable atrioventricular conduction. Transthoracic echocardiography revealed moderate aortic stenosis (calculated valve area, 1.3 cm2) and very severe mitral stenosis (calculated valve area, 0.5 cm2) (see video and Panel A; LA denotes left atrium, LV left ventricle, and MV mitral valve). The left atrium was enlarged, with an indexed atrial volume of 364 ml per square meter (normal value, <35). Color-flow Doppler images (Panel B, upper half) and a continuous-wave Doppler flow pattern (Panel B, lower half) showed the stenotic mitral valve during diastole. The continuous-wave Doppler flow pattern depicts flow velocity (vertical axis) and time (horizontal axis). The slow decline in transmitral flow velocity reflects the very slow decrease in left atrial pressure and slow increase in left ventricular diastolic pressure that occur in mitral stenosis. The mean transmitral gradient was 14 mm Hg (normal value, <3). (see source for video) #clinical #doppler #radiology #NEJM #mitral #stenosis #cardio