Background: Mitral stenosis (MS) is one of the most prevalent valvular heart diseases with relevant morbidity and mortality. Echocardiography is the primary imaging modality for assessing the severity of MS. New transthoracic and transesophageal echo-Doppler modalities (TTE and TEE) have been developed to determine MS severity, which is crucial for diagnostic, therapeutic and prognostic purposes. Objective: Assessment of mitral valve area (MVA) in rheumatic MS patients using different two- and four-dimensional echocardiography studies. Patients and methods: The study included 50 adult patients with moderate to severe MS, whose mean age was 45.64±10.35 years. All study cases were evaluated by TTE followed by TEE using various echo-Doppler modalities. MVA by 3D-TEE full volume-multiplanar reconstruction (FV-MPR) was used as the reference method. Results: There was a statistically highly significant positive correlation between MVA by 3D-TEE FV-MPR and mitral leaflet separation index (MLSI), MVA by (2D planimetry, 3D-TTE, 3D-TEE direct planimetry and mitral valve navigation (MVN)), p value= 0.001. It was found that MLSI value < 0.65 cm can detect severe MS with MVA ≤ 1 cm², with sensitivity 50% and specificity 85%. MVN could detect the severity of MS with 90% sensitivity and 80% specificity at a cut-off value ≤1.2 cm². Conclusion: MS severity should be assessed by different echo-Doppler modalities, with incorporation of recent 3D echo technologies, especially the novel method (MVN); however, more research is required for further validation.