Inclusion Criteria:  Patient age range from 18 years to 60 years. Patient with isolated mitral stenosis (except those with mild mitral regurgitation and are candidate for PTMC by 2D Echo evaluation). Patient with normal left ventricular EF patient both in sinus rhythm or atrial fibrillation  Exclusion Criteria:  Age below 18 years or above 60 years. Patient with another valve lesion or more than mild mitral regurgitation. Patient with impaired cardiac function. Mitral stenosis of other etiology than rheumatic origin