Context: Percutaneous balloon mitral valvuloplasty (PBMV) is often used to treat suitable Mitral stenosis (MS) of rheumatic etiology. This study evaluated the efficacy of measurement of mitral valve regurgitation by 2D echocardiography (2DE). The study also evaluated 3D echocardiography as compared to 2DE for assessment of Mitral valve anatomy and geometry both pre-PBMV and post-PBMV. Materials and Methods: This was prospective, observational single Centre study in which 60 patients of severe mitral stenosis suitable for PBMV were enrolled. The data collection of each patient included demographics, pre-PTBMV and postPTBMV functional class, electrocardiogram (ECG), 2DE & RT3DE both pre and post-PTBMV with special focus on real time 2DE and 3DE assessment of MV anatomy and MV Regurgitation. Post-PBMV, MV Regurgitation and anatomy were assessed in catheterization laboratory using 2DE and RT3DE. Results: There were 32 (53%) females and 28 (47%) males. The mean Pre-PBMV LA Area by 2D Echo (31.38±7.66) and 3D Echo (29.38±7.93) were concordant (p=0.16). Majority patients 24(40%) had mild mitral regurgitation (MR) and only 2(3.3%) had moderate MR before PTBMV. Values of mobility, calcification and subvalvular pathology detected by 2D and 3D Echocardiography showed statistically significant difference (P=0.04 and <0.0001). No significant difference was found in thickness of valve (P=0.29). Higher grades of MR were picked by RT3DE as compared to 2DE. Conclusions: Transthoracic and transesophageal real-time 3D echocardiography (RT3DE) were better in assessing subvalvular pathology, mobility calcification of MV and post-PBMV MR. There was no difference between 2DE and RT3DE for assessment of MV thickness.