Separates rheumatic MS from MAC-related obstruction, post-intervention physiology and prosthetic valves, confirms rheumatic morphology, then integrates valve area (primary) with mean gradient at the recorded heart rate and rhythm, PHT and PASP (supportive). Discordance is reported, not voted away.

1. Separation of rheumatic, degenerative and post-intervention physiology
   What is the mechanism of mitral obstruction and the clinical context?
   Etiology / context — Commissural fusion in the parasternal short-axis view confirms a rheumatic process; MAC involves the base, rheumatic disease the tips—Rheumatic (commissural fusion)Degenerative / mitral annular calcificationWithin 24 h of balloon valvuloplastyPrior commissurotomy / valvuloplasty (>24 h)Prosthetic mitral valveCongenital / other
   The etiology determines which methods and partitions apply.