MS is not an uncommon valvular disease in regions/ population with high incidence of rheumatic fever. Majority of patients present in the third and fourth decade of life and women may present for the first time during pregnancy. Diagnosis and assessment for definitive therapeutic intervention like balloon mitral valvotomy, in moderate to severe MS early in the course of the disease in symptomatic patients is the key to alter the natural history of the disease and its progression favorably, preventing complications and in turn morbidity and mortality.