Percutaneous transvenous mitral commissurotomy, first described in 1984, has gained acceptance as a mode of treatment for patients with symptomatic, severe rheumatic mitral stenosis. The closed surgical technique, one of the oldest cardiovascular surgical procedures, is similar in mechanism to the percutaneous technique. Nonrandomized and randomized trials are reviewed and percutaneous transvenous mitral commissurotomy compares favorably with the closed technique, both in acute hemodynamic changes as well as in long-term result. Although the percutaneous technique is quite different from the open surgical technique, comparisons are appropriate since this is the technique of choice in most industrialized countries. Randomized trials comparing the open versus the percutaneous technique have limited numbers of patients and follow-up, but preliminary data would suggest that the two techniques compare favorably in appropriately selected patients. It appears that percutaneous transvenous mitral commissurotomy has a definite place in the treatment of appropriately selected patients with symptomatic rheumatic mitral stenosis performed in experienced centers.