The Inoue balloon was first used for percutaneous transvenous mitral commissurotomy in 1982 and was commercialized 5 yr later. The experience obtained in thousands of cases performed throughout the world show: (1) the stepwise dilatation technique under echocardiographic guidance appears to be the most efficient and allows the most to be made of this balloon's inherent possibilities, (2) in comparison with other balloon techniques, the advantages of the Inoue balloon are that it is simpler to use, provides equivalent improvement in valve area, and has lower risks, particularly in relation to the production of mitral regurgitation, and (3) long-term results appear similar to those provided by other balloon techniques. Inoue's technique is currently the most widely used for mitral valvuloplasty in the world. Its further development and use depend on further studies of its long-term results together with improvement in the economic aspects.