CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 24 AFRICA lessons learnt could benefit the East African region and beyond. However, the small sample size did not allow detailed analysis. Nevertheless, we have described several parameters known to influence PBMV outcomes. Owing to the possible effect of the small number of patients who underwent PBMV on skills transfer to the local team, our team has several strategies. First, to continue collaborating with the visiting team; the latest mission was conducted from 23 to 26 October 2022 in which five PBMV were performed. Second, two cardiologists will be going to Cleveland, USA, for a six-month visit in order to strengthen their skills. This approach has been done in Uganda and proved to be successful.58 Third, our catheterisation laboratory is equipped with a system that is supporting remote proctoring of interventional procedures. This will allow ongoing supervision of a local team by our collaborators. Lastly, our team was involved in the Africa PBMV workshop held in Tunisia from 24 to 25 August 2022.61 The workshop aimed at building sustainable PBMV programmes across African countries. Conclusion TEE should be carried out on all patients before PBMV to rule out left atrial thrombus. Despite a higher Wilkins score, PBMV can be completed successfully in patients with rheumatic MS who have been carefully screened by the heart team. Patients in AF and with a left atrium > 55 mm should be anticoagulated. The ESC and AHA/ACC guidelines (Wilkin score ≤ 8) for a good outcome of PBMV need reconsideration. PBMV services should be available in catheterisation laboratories in Africa. Enhancing and consolidating PBMV skills among the local team should be undertaken. Our findings are an example of a well-planned development that, if sustained, can make significant differences in the diagnosis, treatment and outcomes of patients with rheumatic MS in low- and middle-income countries. 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