Percutaneous mitral commissurotomy (PMC) has emerged as an effective nonsurgical technique for the treatment of patients with symptomatic mitral stenosis. This report highlights the immediate and long-term follow-up results of this procedure in an unselected cohort of patients with rheumatic mitral stenosis from a single center. PMC with Inoue balloon was performed in 70 patients in a 2-year period (1993-1994). Age of patients ranged from 18 to 67 years (mean 38 +/- 11). Atrial fibrillation was present in 18 (30%) patients. A detailed clinical and echocardiographic (two-dimensional, continuous-wave Doppler and color-flow imaging) assessment was done at follow-up. The procedure was technically successful in 61 (85%) patients with an increase in mitral valve area (MVA) from 0.96 +/- 0.2 to 1.7 +/- 0.28 cm2 (P < .001) and a reduction in mean trans-mitral gradient from 14.3 +/- 4.8 to 6.0 +/- 2.8 mmHg (P < .01). Mitral regurgitation appeared or worsened in 25 (30%) patients, of which 3 (4%) developed severe mitral regurgitation. Urgent mitral valve replacement was performed in these 3 patients. Data of 52 patients followed over a period of 105 +/- 10 months revealed MVA of 1.4 +/- 0.4 cm. Elective mitral valve replacement was done in 14 (23%) patients. Mitral restenosis diagnosed with echocardiography was seen in 24 (50%) patients, of which 14 were having recurrence of class III or more symptoms and were treated with surgery. Thus, percutaneous mitral commissurotomy is an effective and safe procedure and over 2/3 of the patients were event-free at the end of follow-up. The benefits are sustained in most of these patients on long-term follow-up.