Mitral stenosis typically results from rheumatic fever and is a late manifestation of the condition known as rheumatic heart disease. Mitral stenosis is often associated with massive enlargement of the left atrium which results in atrial fibrillation – patients with mitral stenosis are therefore at significant risk of thromboembolic complications. Numerous therapies have developed over time, including mitral commisurotomy, mitral balloon valvuloplasty, and mitral valve replacement. Because mitral stenosis can occur in young women, the management of pregnancy, anticoagulation, and valve replacement can be complex. Understanding the pathophysiology and natural history of mitral stenosis is critical to proper management and the natural history of the patient with a prosthetic mitral valve must also understood by cardiologists and other clinicians working with these patients.