We performed percutaneous double balloon tricuspid valvotomy in four patients (36 +/- 12 years of age), with severe symptomatic rheumatic tricuspid stenosis and mild mitral valve disease. Two 9F Meditech balloon catheters, 15-20 mm diameter, were positioned simultaneously across the tricuspid valve and inflated up to five atmospheres pressure achieving valvotomy. After balloon valvotomy there was symptomatic improvement, and the Doppler tricuspid valve area was increased from a mean of 1 +/- 0.2 to 2.2 +/- 0.2 cm2 (P less than 0.001). At 3-year follow-up the symptomatic improvement persisted and the mean tricuspid valve area was maintained at 2.2 +/- 0.1 cm2. During the follow-up period there was no increase in degree of tricuspid regurgitation assessed by colour Doppler. We conclude that 3 years after balloon valvotomy of the tricuspid valve, the 120% increase in valve area persists, with no objective evidence of restenosis.