Balloon mitral valvuloplasty has, over the last 15 years, become an established interventional procedure. For patients with pliable uncalcified mitral stenosis, dilatation with the Inoue balloon is the intervention of choice, offering results comparable to surgical commissurotomy.¹ In the Western world, however, with the gradual extinction of rheumatic fever, patients with mitral stenosis are now almost exclusively elderly. Such patients tend to have calcified, thickened, and relatively immobile valves, often with significant subvalvar disease, and as such are theoretically unsuited to balloon valvuloplasty.^2 3 But even a small increase in mitral valve orifice may be adequate to allow an elderly person to regain their independence; therefore some have advocated undertaking the interventional option at low risk, with only moderate expectations, rather than opting for mitral valve replacement, with its significant perioperative morbidity and mortality. But is this approach justified?

In this issue of Heart, Sutaria and colleagues describe long term outcome . . . [Full text of this article]