Percutaneous mitral valvuloplasty (PMV) has been proposed as a safe alternative to open mitral commissurotomy (OMC) or mitral valvular replacement (MVR) in selected patients with symptomatic mitral stenosis (MS). Among 146 consecutive patients who underwent PMV between March 1987 and April 1990, 18 (12%) needed urgent corrective surgery after the procedure. Of these 18 patients 16 were women and 2 were men. Three patients were of clinical incapacity class II and 15 of class III and were at an intermediate risk for PMV according to the echo score (mean score 8). The indications for corrective surgery were massive mitral regurgitation owing to tearing of the anterior leaflet (six patients), cardiac perforation (left atrium in two patients, left ventricle in three patients), technical failure of PMV (five patients) and severe atrial shunting (two patients). Operative procedures included MVR (14 patients), cardiac wound suturing only (3 patients) and OMC (1 patient). Operative mortality (within 30 days) was 22% (4 of 18 patients), distributed equally among patients needing urgent or elective surgery. When compared with the operative death rate after OMC (0%) and MVR (3.1%) as the initial treatment for MS during the same period, the rate for cardiac operation after failed or complicated PMV (22%) was significantly higher (p = 0.004). Therefore, optimal patient selection and aggressive corrective surgery are necessary to decrease PMV-related morbidity and death.