Percutaneous Transvenous Mitral Commissurotomy (PTMC) is an alternative to surgical mitral valvuloplasty for treatment of selected patients with rheumatic mitral stenosis. We report our initial experience with the technique in 10 patients. The procedure was successful in all patients. There were no major complications. Mitral valve area increased from a mean (+/- SD) of 0.95 +/- 0.2 to 2.18 +/- 0.8 cm2. Transmitral pressure gradient fell from 12 +/- 8 to 4 +/- 5 mmHg while New York Heart Association functional class improved by 1 grade or more in all patients. PTMC is a safe and cost effective alternative to surgical mitral valvotomy in appropriately selected cases.