Percutaneous balloon mitral valvotomy is a technique that allows relief of mitral stenosis without thoracotomy. Commissurotomy of the mitral valve with proper sized balloons that are placed antegrade by means of a transseptal catheterization results in good immediate and midterm results in most patients. Younger patients with echocardiographic scores of 8 or lower and who are without atrial fibrillation, mitral regurgitation or valvular calcification, and histories of surgical commissurotomy are the best candidates for PMV. Nevertheless, many patients who are not ideal candidates for PMV also derive substantial relief from this procedure. Mortality and morbidity related to the procedure are low in most experienced centers. Complications include pericardial tamponade, thromboembolism, rhythm abnormalities, left to right shunting, and mitral regurgitation. The survival with freedom from mitral valve replacement at 2 years after PMV is 84%. In addition to history and physical examination, echocardiography has a central role in the selection of patients for PMV.