Rheumatic heart disease continues to be a major health problem in developing countries with poor financial resources. Mitral stenosis is a common expression of rheumatic insult. The time of onset of symptoms in these poor patients is usually in the most productive years of life with serious impact on the economic and health status. The Inoue balloon is the current method of choice of dilatation of mitral stenosis and has proven itself comparable to surgical commissurotomy and is preferred by most operators because of its ease of use compared with other available techniques. However, the high cost of a ballon set is its one-off use which represents a burden on the budgets of most cath labs in the developing countries. Also its limiting success in dilating calcified and deformed valve restricts its use to a selected population of mitral stenosis patients with a large proportion of these patients eventually requiring some form of surgical intervention instead.