The efficacy and complications of three different methods of percutaneous mitral valvuloplasty (PMV) were evaluated in 245 patients with mitral stenosis (MS). Eight six patients (35%) had severe MS defined in the mitral valve area (MVA) less than 1.0 cm2 (0.8 +/- 0.2) and Echoscore greater than or equal to 8(8.9 +/- 1.1). The results including post MCA greater than or equal to 1.5cm2 and complications, i.e, increment of mitral regurgitation (MR) greater than or equal to +1 and atrial septal defect (ASD) with Qp/Qs greater than or equal to 1.5 were compared in overall and in severe MS groups. There was no statistically significant difference in size of MVA before and after PMV between overall patients group and severe mitral stenosis group (0.8 +/- 0.1 vs 1.7 +/- 0.4cm2 in the double technique, 0.8 +/- 0.2 vs 1.5 +/- 0.3cm2 in the Bifoil technique and 0.7 +/- 0.2 vs 1.8 +/- 0.3cm2 in the Inoue technique. p: NS). However, a significantly larger number of patients in the severe MS group had better MVA with the double than the Bifoil technique [MVA greater than or equal to 1.5cm2; 42 (72%) vs 6 (46%), p less than 0.005] whereas higher complications were observed with the Bifoil than the Inoue technique (MR greater than or equal to +1; 9 (69%) vs 4 (27%), ASD (Qp/Qs greater than or equal to 1.5' 6 (46%) vs 2 (13%) p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)