Although the incidence of rheumatic fever and the prevalence of rheumatic heart disease are decreasing , a small but substantial occurrence of rheumatic MS exists in Asia. Percutaneous  MitralValvuloplasty (PMV) using Inoue balloon is still considered as first long-lasting temporary treatment of choice for mitral valve stenosis. Forgetting optimal results, the need for adequate understanding of indications, procedures, and assessment of results cannot be overemphasized. In our experience of nearly 6000 cases of PMV, some tips and tricks can be shared:

    ●Echocardiography still plays a major role for proper patient selestion by using echo score as well as the balance of both commissurors;

  ●Balloon selection should base on the patients’ height and the valve and sub-valvular status;

    ●Septal puncture is vital component of PMV, it is not only avoid tamponade, but also made an appropriate septal siteto facilitate balloon crossing valve. The hash sign landmark using Left Atrial border and punture-needle/catheter fitting exercice can be used as symplist technique of this vital step;

    ●“Physiological technique”for crossing the mitral valve was the favor technique for the PMV;

    ●PMV also could be performed in some special scenarios such as pregnancy, LAA thrombus, giant LA/RA, kyphoscoliosis, form the left femoralsite with the carefully looking at the LA boder, tip of needle, big-loop method.

     In conclusion, proper patient and balloon selection, careful attention to“physiological techniques” are the keys to success with optimizing results andminimizing complications.