Mitral valvuloplasty is associated with low operative mortality, preservation of ventricular function, reduced valve-related complications, decreased requirement for anticoagulation therapy, improved long-term survival, and decreased cost. It should be undertaken after careful consideration of the individual patient's pathophysiology and pathoanatomy, including a thorough clinical and echocardiographic evaluation. In these selected cases, an excellent surgical result can be obtained with valve repair, eliminating the risks associated with prosthetic mitral valve replacement.