Since its introduction as an alternative to surgical commissurotomy, percutaneous mitral valvuloplasty (PMV) has been preformed in a wide range of patients. PMV improves valve function significantly, and provides a final valve area of 2 cm2. The quality of the results is mainly related to valve anatomy. The incidence of complications is relatively low: death 0.5%, severe mitral incompetence 4%, and left to right shunts, as assessed by oximetry 20% of which two thirds disappear during follow-up. As of now, only mid-term follow-up results are available. If the initial result is good, functional improvement occurs in most cases and re-stenosis is rare. On the other hand, secondary surgery is most often necessary in case of poor initial result or severe mitral regurgitation complicating PMV. These favorable results lead us to propose PMV as the first treatment for mitral stenosis with pliable valves. On the contrary, valve replacement remains the main treatment in calcific stenosis, PMV being restricted to particular cases: mild calcification, high surgical risk or even refusal of surgery. Finally, the decision of PMV can only be taken after exclusion of contraindications: left atrial thrombosis, moderate to severe mitral regurgitation.