Balloon Mitral Valvotomy (BMV) is one the preferred modality of treatment for Rheumatic mitral stenosis. This is usually performed with onsite surgical backup to tackle the complications like cardiac tamponade needing surgical drainage and severe mitral regurgitation which requires emergency Mitral Valve Replacement. Our aim is to evaluate the pre and post procedural outcomes of the BMV. The immediate and one year clinical and echocardiographic results of 88 consecutive patients who underwent BMV for severe mitral stenosis between  September 2016 to Jan 2018 from in our tertiary care hospital. All symptomatic patients (NYHA class II– IV) with their mitral valve area (MVA ) <1.0cm2 were enrolled. Detail clinical evaluation and Echocardiography was done before and after the procedure. The procedure was performed under local anesthesia, using the step–wise Inoue balloon dilation with the ante grade transvenous approach. The successful procedure was 87 (98.7 %). The mean age was 35 ± 13 years, mean pre BMV MVA= 0.8 ± 0.18 cm2, mean Post BMV MVA =1.71 ± 0.24 cm2, by plannimetry (p < 0.0001). . The hemodynamic mean diastolic gradient decreased from 16.1 ± 5.3 mmHg to 3.8 ± 2.6 mmHg (p < 0.0001). The mean left atrial pressure was reduced from 23.42 ± 6.89 mmHg to 11.8 ± 4.1 mmHg (p < 0.0001). Minor complication like puncture site hematoma in 3 (3.44%) patients, vasovagal attack in 6 (6.89%) patients after intra atrial septal puncture, Ventricular arrhythmia in 1(1.4%) patients and supraventricular arrhythmia in 11 (12.64%) patients. Severe mitral regurgitation occurred in 5 (5.74%) patients out of which three patients managed medically and one patient required urgent MVR. Cardiac tamponade developed in 1(1.4%) patient, pericardiocentesis done. The one year follow up mean mitral valve area was 1.56 ± 0.19 cm2, restenosis rate was 21.83%; and 90% of patients were in class I – II. Balloon Mitral Valvotomy is safe and effective procedure for patient with severe and symptomatic patient with Rheumatic MS with lower complication rate and good clinical improvement.