Embolic phenomena is a potential and severe complication of percutaneous balloon mitral valvuloplasty (BMV) and can be devastating, since the rheumatic process itself is quite prevalent in the younger population (the average age of a person undergoing BMV in our institution is 27.9 years). The incidence of systemic embolism during BMV has been reported to be less than 5% and only 0.6% with the Inoue technique. Incidence and etiology, risk factors for systemic embolism during BMV, predictors of systemic embolism in patients undergoing BMV, neurological embolism and its management, and role of transesophageal echocardiography (TEE) in preventing thromboembolic episodes during BMV are covered in this chapter.