Objective  To retrospectively review the experience of mitral valve replacement after mitral commissurotomy in 39 cases. Methods  39 patients[male 18,female 21;average age (45.3±5.2) years old,ranging from 23 to 63] underwent mitral valve replacement (MVR)from August 1995 to November 2002,among whom 5 suffered from restenosis after percutaneous balloon mitral valvoplasty(PBMV)and 34 after closed mitral commissurotomy(CMC). 5 cases underwent emergent operation and the rest did selectively. The average interval from PBMV or CMC to MVR was (11.2±4.9) years. All of the operations were performed under hypothermia and cardiopulmonary bypass(CPB) through right atrial and atrial septal incisions. Results  The early-stage postoperative mortality was 5.1%(2/39). 1 case died of low cardiac output syndrome and 1 of left atrium rupture in this group. The cardiac function status in the survivors was significantly improved. Conclusions  The factors decreasing hospital mortality of reoperation on mitral valve include: avoiding too much dissection of the adherence pericardium during operation; exposing the mitral valve through right atrial and atrial septal incisions; excellent myocardial protection; prompt and correct perioperative managements of the patients.