1) Closed mitral valvuloplasty is uncommonly performed in this country, but is some other parts of the world .It consists of inserting one finger into the left atrium through a purse string suture to guide a dilator through the left apex into the mitral valve and expanding it to give the valve a predetermined size.

2) Open mitral valvuloplasty (the choice in the USA when the valve is not too heavilly calcified and chordal fusion not too extentive) allows more precise direct visual reconstruction of the valve than either the closed or percutaneous techniques.With the use of cardiopulmonary bypass and cardioplegic myocardial protection, the mitral valve is exposed and its commissures examined and carefully incised. Fused chordae can be split, as can papillary muscles.