What is the best view to evaluate mitral stenosis?

• A. Parasternal long-axis view
• B. PSAX @MV
• C. Apical four-chamber view
• D. Subcostal view

Answer: (B)

For evaluating mitral stenosis, the most reliable measure is the mitral valve area, which is best obtained by planimetry in the short-axis view at the level of the mitral valve. In the parasternal short-axis view, you can visualize the mitral orifice en face and trace the opening during diastole to calculate the area directly. While Doppler gradients (often assessed in the apical four-chamber view with Doppler) are important for overall severity, they don’t provide the direct anatomic area measurement as clearly as the short-axis plane does. Other views don’t place the orifice in a favorable cross-section for accurate planimetry—the long-axis view shows the valve more obliquely, the apical four-chamber is better for velocity measurements across the valve, and subcostal windows can be limited by patient anatomy. So, the parasternal short-axis view through the mitral valve is the best choice for assessing mitral stenosis.