Skeletal muscle (SM) abnormalities, which may play a role in dyspnoea and fatigue in cardiomyopathic heart failure, could be involved in causing similar symptoms in mitral stenosis. We studied the effects of percutaneous balloon mitral valvuloplasty (BMV) on SM structure and function in eight patients; before BMV as baseline, 2 weeks after BMV for effects of improved haemodynamics and 4 months after BMV for effects of resumption of normal physical activity. Patients underwent (i) exercise (25 W/ 3 min stages) to exhaustion to determine Vos,max, (ii) CT scan for right quadriceps cross-sectional area, (iii) isokinetic testing of peak quadriceps torque (60 deg s-') and fatigue (% force decrease after min of repetitive contraction/ relaxation cycles at 180 deg s') and (iv) quadriceps biopsy for histological (fibre type) and citrate synthase analysis. BMV caused an increase in mitral valve area (0i86 + 0 07 to 182 + 013 cm2 (mean +S.E.M.), P< 0-01), which remained elevated at 4 months (1P76 + 0413 cm2, P < 0-01), and an increase in cardiac output (3-8 + 0418 to 4-6 + 04191 mint, P< 0 05).