BACKGROUND Percutaneous balloon mitral commissurotomy (PMBC) is an engaging therapy in patients with mitral valve (MV) stenosis and pulmonary hypertension (PH). The objective of this study was to analyze the effect of immediate and long-term outcomes in patients with severe PH due to theumatic mitral valve disease submitted to PMBC in a single tertiary center. METHODS Throughout 2 decades of experience, a total of 1,925 PMBC procedures were performed (1987 to 2011) at a single center, in which 147 patients had significant PH defined as baseline estimated pul monary artery systolic pressure (ePASP) >75 mm Hg. Outcomes during follow-up were analyzed: all-cause mortality, need for MV replace- ment, new PMBC, and restenosis. RESULTS Mean age was 33.8 plus/minus 12.8 years, and 83.6% (n - 123) were women. Primary success was achieved in 89.8% of patients (n - 132) Mitral valve area increased immediately from 0.83 plus/minus 0.17 2.03 plus/minus 0.35 * cn (P < 0.001) and throughout 20 years, MV area was L * 46 plus/minus 0.34 * c * m ^ 2 P = 0.235 ) Levels of ePASP decreased from 87.0 plus/minus 6 60 plus/minus 0.9 Hg (P < 0.0001) All-cause mortality, need for MV replacement, new PMBC, and restenosis were 0.67%, 20.0%, 8.78%, and 30.4%, respectively, in long-term follow-up (mean 15.6 plus/minus 4.9 years). CONCLUSIONS PMBC is an effective and safe technique for the treatment of patients with MV rheumatic disease and PH. There was an expected progressive and nonsignificant decrease of MV area at long-term follow-up, and most patients remained asymptomatic and free of outcomes throughout the years.