Percutaneous balloon mitral valvuloplasty(PMV) was comparable to surgical commissurotomy in initial and long term follow-up results in selected patients with symptomatic severe mitral stenosis. Transseptal puncture was necessary for antegrade introduction of balloon. In patient with kyphoscoliosis, PMV was relatively contraindicatied due to difficulty and risk of septal puncture. We performed the PMV in a patient with kyphoscoliosis and severe mitral stenosis. The patient was presented with NYHA class III. Echocardiographic evaluation revealed mitral valve area of 0.8cm2 and mean diastolic pressure gradient of 12mmHg. X-ray film of T-L spine showed severe kyphoscoliosis. Transseptal puncture was possible with modification of angle of Brockenbrough needle at the site of 15cm from the needle tip. After transseptal puncture, Inoue balloon was introduced into the LV and gradual ballooning was performed with optimal results. Hemodynamic variable were improved immediately after intervention and mitral valve area was increased from 0.7cm2 to 1.8cm2. Patient was discharged with NYHA class I.