Despite claims of good results with percutaneous balloon mitral commissurotomy (PBMC), open mitral commissurotomy (OMC) remains our method of choice for the treatment of rheumatic mitral valve stenosis. In a series of OMC performed between 1988 and 1991, involving 100 patients with pliable mitral valves, we achieved a mean valve area of 2.89 ± 0.49cm² (preoperative 0.99 ± 0.23cm²). In a recent follow up, after a mean of 8.5 years (range: 7-11 years), the mean valve areas measured by echo-Doppler was 2.37 ± 0.42cm² (range: 1.6 Ð 3.6 cm²). Reoperation was required in only two patients. Late mortality rate was 4% (0.5% per pt-yr), and was in no case valve-related. The nine-year actuarial survival rate was 96%, freedom from reoperation 98%, and freedom from all valve-related complications 92%. In our experience, the medium- and long-term results of OMC are significantly better than those usually reported in PBMC series.