Objective To summarize the experience of operation treatment of severe mitral stenosis associated with small left ventricle.Methods The clinical data of 115 patients with severe mitral stenosis received mitral valve replacement (MVR) were retrospectively analyzed.According to whether associated with small left ventricle,they were divided into small left ventricle group (61 cases) and non-small left ventricle group (54 cases).The postoperative early complication rate and mortality rate between two groups were compared.Results The postoperative early complication rate and mortality rate in small left ventricle group was higher than that in non-small left ventricle group [14.75％ (9/61) vs.7.41％ (4/54),55.74％ (34/61) vs.25.93％(14/54)],there was significant difference(P ＜ 0.05).Conclusions The positive and effective perioperative management and correct intraoperative decision is key to reduce the incidence of early postoperative complications and mortality after MVR surgical in patients with severe mitral stenosis associated with small left ventricle.