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Summary Studies have been made of 87 patients treated by finger‐fracture valvotomy for mitral stenosis five or more years ago, and of 224 patients followed for only two years. At the time of operation the mean age of the patients was 38 years, and 34% had atrial fibrillation. The functional classification of the patients and the results of the operation in each group are presented. The operative mortality was 5%, but ranged from 2.5 % in Class II patients to 25% in Class IV patients. When the total number operated on is used as the base line, 61% of patients had a good result (improvement by at least one functional class) at two years. At five years this figure had fallen to 51%. The best results were obtained in the less severe cases. Age in itself did not materially affect the outcome, but atrial fibrillation, whose incidence increased with age, lessened the prospects of success. Considerable cardiac enlargement was also an adverse factor. Mitral incompetence present before operation or produced by surgery had an unfavourable effect on the outcome, and severe incompetence proved lethal. When moderate incompetence was present after operation, roughly two‐thirds of the patients had a good result at two years, but this figure fell to one‐third by five years. The most significant factor in continued post‐operative improvement was the completeness of separation of the adherent valve cusps. Division of one commissure gave temporary benefit to many patients, but by five years only one in four maintained their improvement. Deterioration was due to restenosis, which may also occur even when both commissures are adequately split. We conclude that mitral valvotomy as originally practised leaves much to be desired. The pathology of advanced mitral stenosis does not readily lend itself to correction. We advise surgical treatment early in the disease, when disability is first noticeable and atrial fibrillation, embolism and valvular distortion have not occurred. The results of more recent surgical techniques, although initially encouraging, remain to be evaluated.

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