Closed Mitral Valvotomy : This has been 1-eplaced by balloon mitral valvotomy (BMV) in most centres. It is done in cases of either pure mitral stenosis or with .trivial regurgitation. The patient should be in sinus rhythm and echo should prove the suitability for a closed valvotomy just as for a balloon mitral valvotamy. Heavy calcification in the commissures and edges of the cusps, moderate MR and the presence of a left 38 atrial clot are contra indication for closed mitral valvotomy.