Percutaneous mitral valvotomy (PMV) has become the treatment of choice for rheumatic mitral stenosis (MS). PMV yield results similar to open surgical commissurotomy and better results than closed commissurotomy. Juvenile MS has been defined as symptomatic MS in age less than 20 years. The incidence of juvenile mitral stenosis ranged from 16–27% in these series of PMV. Indication for PMV in juvenile mitral stenosis, valve morphology, PMV procedure in juvenile mitral stenosis, vascular access, balloon selection and dilatation, immediate hemodynamic results, and complications are covered in this chapter. As compared to adults, PMV in juveniles is associated with a low complication rates. Low complication rates in this group are attributed to the more favorable valve anatomy in the young as demonstrated by a lower echocardiographic score.