If PMBC is being considered, a TEE can further evaluate the presence and severity of concomitant MR and rule out LA thrombus. Recommendation-Specific Supportive Text 1. TTE is the imaging modality of choice to eluci- date the anatomy and functional significance of rheumatic MS.1 The parasternal long-axis window can identify the characteristic diastolic doming of the mitral valve, whereas short-axis scanning will demonstrate commissural fusion and allow planimetry of the mitral orifice. Use of 3D echocardiography (either TTE or TEE) pro- vides greater accuracy of measurement of the mitral valve area.7,8 Doppler echocardiography mean transvalvular gradients always should be reported with heart rate because a high heart rate will result in overestimation of stenosis severity.9 Estimated RV systolic pressure is obtained from the TR velocity. Concomitant MR should be quan- tified, along with any other valve lesions (Section 7.3.1.1). Several scores are available for evalua- tion of mitral valve morphology and prediction of outcomes with PMBC, and these scores consider valve thickening, mobility, and calcification with subvalvular chordal fusion.10,11 Characterization of commissural morphology and calcification fur- ther predicts suitability for commissurotomy.2,3,12,13 Additional assessment of rheumatic MS includes the mitral pressure half-time, with acknowledg- ment that this parameter is also affected by LA and LV compliance. If the mean gradient does not match the valve area, other methods, such as the continuity equation, should be considered.14 2. TEE offers excellent visualization of the mitral valve and LA and is an alternative approach to assessment of rheumatic MS in patients whose TTE images are technically limited. 