Background: Mitral valve complications can lead to the serious consequence of pulmonary arterial hypertension (PAH). It has long been believed that the onset of PAH increases the chance of a poor outcome in individuals having mitral valve replacement surgery (MVR). Objective: The aim of the present study was to assess and improve the early outcome after MVR in patients with pulmonary hypertension. Patients and methods: This study included forty-eight patients undergoing MVR at the Cardiothoracic Surgery Department, Suez Canal University Hospital. Patients were divided into: group (A) 25 patients: with mild to moderate pulmonary hypertension; and group (B) 23 patients: with severe pulmonary hypertension. Transthoracic Doppler echocardiography, systolic pulmonary arterial pressure (sPAP), left atrium diameter (LAD), left ventricular end-diastolic dimensions (LVEDD), left ventricular end systolic dimensions (LVESD), fraction shortening (FS) and left ejection fraction (LEF), were evaluated and compared in all patients. Results: Mitral valve pathology was non-significantly different between the two groups. However, number of patients who had grade III IV tricuspid regurge was significantly higher in group B. The ventilation duration in group B was significantly longer than group A. The duration of weaning from inotropic support was significantly longer in group B. We found no significant difference between the two groups regarding postoperative complications and mortality with postoperative mortality of 4.3% in group B. Conclusion: Pulmonary arterial systolic pressure decreased near normal value in most patients after surgery.