Closed mitral valvotomy was performed in 153 patients with rheumatic mitral stenosis over a 25-year period ending in December 1999. There were 65 (42.5%) males and 88 (57.5%) females with an age range from 8 to 19 years {mean 14.8 ± 2.7). The most common presentation of the patients includes exertional dyspnea, palpitation, cough, chest pain, congestive heart failure and hemoptysis. According to New York Heart Association (NYHA) functional class 13 patients (8.5%) were in class II, 112 (73.2%) in class 111, and 28 (18.3%) in class IV. Preoperative echocardiogra-phy was done for 133 patients (86.9%). All of them had echocardio-graphic score < 8 with mitral valve area ranged from 0.6 to 1.1 cm2 with a mean value of 0.761 ± 0.21 crr>2. Three patients (2%) died in the early postoperative period. Ten patients (6.5%) developed postoperative complications. Postoperatively, the mean valve area achieved was 2.67 ± 0.38 cm2. Of the 150 patients who survived the operation, 28 patients were excluded from the last foilow-up, 9 (6%) required reoperation, 8 (5.2%) died late postoperatively, and 11 (7.2%) lost the follow-up. The most recent follow-up data were available for 122 patients (79.7%). In a recent follow-up, conducted after a mean of 10.3 ± 5.8 years (range: 1-24 years), the mean valve area measured by echo-Doppler in this patient group was 2.12 ± 0.41 cm2 (range: 1.4-2.9 cm2). Nine patients subsequently underwent reoperation for the mitral valve; 6 closed revalvotomy, and 3 valve replacement. The late mortality rate was 5.2%. Most of the patients (97.7%) were in NYHA functional