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Background: Wilkins score evaluates leaflet quality by its thickness, mobility, calcification, and the extent of subvalvular disease.A score of-3d8 has an excellent immediate and long term result, whereas scores > 8 have poor outcomes.In India as there is late presentation with advanced rheumatic MS disease, a large number patients will be deprived of BMV if strictly Wilkins score is followed up.Objective: To analyse the possibility of percutanous ballon mitral valvuloplasty in patients with mital stenosis with high Wilkin score Material and Methods: At ICVS, IPGME&R, Kolkata, which is a very high volume center in Eastern India, we performed BMV in patients with a Wilkins score of>/=8.Here we present a data of 546 cases over a period of 3 years from January 2007 to March 2010.Results: Out of total number of cases 47 % had Wilkins score > 8 and 53% had a score of< 8.Our study showed that we have performed BMV in a considerable number of cases (47%) with unsuitable valve morphology according to Wilkins score.41% of these poor valve morphology cases had been redo cases, either post CMC or post BMV.Success rate was comparable.Successful BMV was considered when mitral valve area was increased by > 1 cm/m2 body surface area from the initial orifice size or a decrease in mean transmitral gradient to < 5 mmHg.95% CI of success rate for Wilkins score <8 is 96.92% [93.95-99.89%] & for Wilkins score >8 is 90.52% [84.91-96.12%].Fishers exact test 2-tailed p value is 0.059.With unfavorable valve morphology, underdilatation was done with achieving a valve area ≈98 1.8sqcm.By underdilatation, leaflet tear and chordal rupture resulting in MR were prevented.Only 11 cases had to undergo emergency surgery as a result of MR.Complications included MR requiring surgery(p-0.259), tamponade (p-0.739),systemic embolisation, ASD, death (p-0.603).Conclusion: BMV can be safely done even in patients with high Wilkins score and young rheumatic MS patients should not be deprived of the opportunity of BMV just on basis of a particular score.Management strategy should be individualized.