Surgical treatment of mitral stenosis is one of the first heart operations that consistently provided relief of symptoms and improved survival. Two surgeons, Charles Bailey in Philadelphia and Dwight Harken in Boston performed the first successful closed mitral commissurotomy almost simultaneously (4 days apart) in June of 1948.1 The relief of the inflow obstruction resulted in immediate improvement of patients’ clinical picture. The initial success led to the refinement of the technique by introduction of a special valve dilatator. Tubbs from the UK perfected the valve dilatator developed by Dr Logan, which is named after him.1 ,2 Closed mitral commissurotomy is performed through a left thoracotomy in the beating heart without cardiopulmonary bypass by inserting the dilatator through the left ventricular apex and opening its arms inside the mitral leaflets. The surgeon cannot see, but feel the changes that occur in the valve by the index finger inserted in the left atrium through the appendage. The dilatation can be repeated by enlarging the dilatator's arms providing excellent long-term outcomes.3 ,4 Although closed commissurotomy is abandoned in USA and Western countries, giving way to open heart surgery, it is still in use in many parts of the developing world.4Open commissurotomy is performed through sternotomy using cardiopulmonary bypass. The surgeon inspects the mitral valve with direct vision, debrides the calcific deposits and separates the fused commissures with the blade.

Balloon commissurotomy was first tested by Dr Inoue in the surgical setting in 1982. Transvenous percutaneous balloon commissurotomy was performed for the first time by Dr Inoue in 1984 via transseptal route.5 The mitral valve opening was enlarged by forcing the commissures to split with the inflating balloon, in a manner similar to the …