Pearly heart is a typical clinical manifestation of mitral stenosis, and a common pathogenetic factor in mitral stenosis is rheumatic fever. For pearly heart due to mitral stenosis, penicillin, 1.2 million units intramuscularly once a month, can be given for a long time, even for life. For pearly heart due to mitral stenosis, surgical treatment is also possible. The first common form of treatment, there is percutaneous balloon mitral valvuloplasty, in which a balloon is passed from the femoral vein through the interatrial septum, across the mitral valve, and the valve is separated by filling the balloon with saline and contrast. The second surgical procedure is mitral valve separation, which is available in both direct and closed forms, with better results and lower operative mortality with direct visualization. The third surgical procedure is prosthetic valve replacement, which means that if mitral stenosis is severe enough, the left atrium can be enlarged and pear-shaped heart can be alleviated by replacing the prosthetic valve.