Aims: The objective was to study the safety and efficacy of balloon mitral valvotomy in rheumatic severe mitral stenotic adult patients and to evaluate the clinical, echocardiographic and haemodynamic profile both before and immediately after the procedure. Methods: Forty adult patients aged 24yrs or older were taken for the study. All underwent balloon mitral valvotomy. We used Accura balloon in our institution. The procedure was successful in all the patients. Then clinical, echocardiographic and haemodynamic parameters were analysed before and after the procedure. Results: New York Heart Association functional class was II and III in 60% and 40% respectively. Atrial fibrillation was seen in the 25% of the patients. Mitral valve deformity as per wilkins score was 8.6 ± 0.67. Mitral valve area index by 2D echo was 0.621±0.097 cm2/m2, Mitral valve gradient 14.63±5.33 mm hg, and mean PASP was 60.10±19.32 mm of hg, after intervention the values were 1.29±0.18cm2/m2,(0.0001), 5.78±2.24 mm of hg, (p < 0.001) and 41±15.62 respectively (p = 0.0001). The mean value for left atrial pressure before 24.9±6.77mmhg and after 14.20± 4.92mmhg, significantly lower after balloon mitral valvotomy (p value 0.0001). The procedural success was 100%. Conclusion: Balloon mitral valvotomy is safe and effective in Adult rheumatic mitral stenosis and provides better immediate results.