Closed commissurotomy · Closed mitral valvotomy - involves the use of mechanical dilators, inserted through the apex of the left ventricle. It is complicated by mitral regurgitation, systemic embolization and restenosis. · Balloon valvuloplasty (a form of closed commissurotomy) - percutaneous trans-septal balloon mitral valvotomy (or valvuloplasty). Remember, percutaneous balloon dilatation of the mitral valve is a useful option in patients who are unable to undergo cardiac surgery, as in late pregnancy or when too ill (severe respiratory disease, non-mitral cardiac disease, multiorgan failure). Open commissurotomy Requires cardiopulmonary bypass and allows surgical repair of the valve under direct vision, resulting in more effective and safer valvotomy than the closed procedure. Valve replacement Entails risks including thromboembolism, endocarditis and primary valve failure.