The aim of this chapter is to focus on the comparison of percutaneous mitral valvotomy and surgical mitral commissurotomy. Subsequent to its introduction by Inoue et al. in 1984, percutaneous mitral valvotomy (PMV) has become the procedure of choice in management of selected patients with symptomatic mitral stenosis (MS). Various studies and series have established the favorable outcomes of the procedure along with the safety of the procedure. Still, surgical mitral commissurotomy is indicated in isolated pliable mitral stenosis in the presence of left atrial thrombus (open mitral commissurotomy—OMC) or an associated condition requiring surgical correction (e.g. significant aortic valve disease). Percutaneous mitral valvotomy versus surgical commissurotomy in pregnancy, calcific mitral valve, and mitral restenosis are covered in this chapter.