Increasing SOB and DOE

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Short case presentation
79 yo F with history of Latex allergy, childhood RF, Mitral Commissurotomy 53 years ago, CHF, AF, SSS, a DDD pacemaker , with progressive SOB and DOE.Cardiac catheterization  showed no coronary artery disease. What is the cause of the SOB/DOE? Any other valvular abnormalities? Please review the accuracy of methods of calculating the mitral valve area.