Classic Procedure: The approach is the same as described earlier for open mitral valvotomy. The excision starts with an anterior incision on the anterior leaflet at 12o'clock position, 2mm distal to the annulus. The incision is extended. The anterior leaflet with the chordae and the tip of the papillary muscle are removed. If the posterior leaflet is calcified, it is also excised along with chordae and tips of papillary muscles. Over zealous excision and suturing may cause venticular rupture or damage to circumflex coronary arteiy. Valve size is assessed according to the type of valve selected by the surgeon. The valve can be sutured by a continuous suture technique or interrupted pledgetted mattress sutures using 2 '0' braided polyester sutures. The pledgets are usually placed on the atrial aspect or rarely on the ventricular aspect.