Rheumatic mitral stenosis is still common in sub-Saharan Africa. The aim of this study was to evaluate the clinical and echocardiographic contraindications to the realization of percutaneous mitral commissurotomy (PMC) in Abidjan Heart Institute. We conducted a prospective, transversal and analytical study in the Exploration Unit from March 30, 2017 to March 30, 2018. Mitral stenosis was severe with an average anatomical surface area of 0.87cm2, an average gradient of 13.7 mmHg and an upstream repercussion (dilatation of the left atrium (78 ml/m2); moderate dilatation of the right atrium (22.3 cm2) and average pulmonary arterial hypertension (PAH) of 55 mmHg). The main clinical contraindications were a history of rest dyspnoea at 66.7%, permanent atrial fibrillation at 53.3 % and clinical manifestations of severe PAH in 40 %. Unfavourable anatomy (95.7 %) evaluated by scores of Wilkins, Cormier and especially Echoscore revisited; bicommissural fusion (95.7 %) and severe aortic valvulopathy (31.1%) were the main barriers in transthoracic echocardiography. In multivariate analysis after linear regression, valvular anatomy, as assessed by the various scores, was significantly related to low socioeconomic status (p=0.018), level of education (p=0.04), severity of mitral stenosis evaluated by the mean gradient (p=0.033) and the impact on the left atrium (p=0.015). Mitral stenosis presents several clinical and echocardiographic contraindications. Adverse anatomy is the main obstacle and is related to low socio-economic status, educational level and severity of stenosis.