【Abstract】Objective To discuss the treatment strategy for rheumatic mitral stenosis associated with small left ventricle during the perioperative period. Methods The clinical data of 19 patients received surgical treatments due to rheumatic mitral stenosis associated with small left ventricle from January, 2013 to January, 2016 were selected. The experience and knowledge of treatment during the perioperative period were explored. Results Among the 19 patients, 18 patients had the surgeries completed successfully and 1 patient died from left ventricle rupture during the surgery. 1 patient died from multiple organ dysfunction caused by low cardiac output syndrome after the surgery, and the mortality was 10.5%. After the surgeries, 4 cases reported low cardiac output syndrome, 4 cases reported arrhythmia, 6 cases reported pulmonary infection, 2 cases reported acute renal insufficiency and 1 case reported incision infection. All of the 17 cases had been given corresponding treatments and postdischarge followups for a followup period of 8~44 months. All patients reported normal survival. 10 cases had the cardiac function restored to level I and 7 cases restored to level II. Ultrasonic cardiogram noted: the left ventricular and diastolic diameter(LVEDD) was 46.5±5.4mm, and the ejection fraction was 48%~75%. Conclusion The condition of patients with rheumatic mitral stenosis associated with small left ventricle is critical, if not treated properly during the perioperative period, it will be extremely easy for the patients to have severe postoperative complications, such as low cardiac output syndrome, pulmonary hypertensive crisis and ventricular arrhythmia and so on. The active maintenance of the cardiac function and the correction of the general situation before the surgery, the accurate determination of the surgical procedures during the surgery, the intensive postoperative care, the rational use of vasoconstrictor drugs, the proper fluid infusion to correct low cardiac output syndrome, and the active treatment of arrhythmia are the keys to bring down the incidence and mortality of early complications after surgeries.