Abstract Severe mitral regurgitation (MR) following mitral balloon valvuloplasty is a major complication of this procedure. We recently described a new echocardiographic score that can predict the development of severe MR following mitral valvuloplasty with the double balloon technique. The present study was designed to test the usefulness of this score for predicting severe MR in patients undergoing the procedure using the Inoue balloon technique. From 117 consecutive patients who underwent mitral valvuloplasty using the Inoue technique, 14 (11.9%) developed severe MR after the procedure. A good quality echocardiogram before mitral valvuloplasty was available in 11 patients. These 11 patients were matched by age, sex, mitral valve area, and degree of MR before valvuloplasty with 69 randomly selected patients who did not develop severe MR after Inoue valvuloplasty. The total MR-echocardiographic (MR-echo) score was significantly greater in the severe MR group (10.5 ± 1.4 vs 8.2 ± 1.1; p <0.001). In addition, the component grades for the anterior leaflet (2.9 ± 0.5 vs 2.2 ± 0.4; p <0.001), posterior leaflet (2.6 ± 0.7 vs 1.9 ± 0.8), commissures (2.4 ± 0.8 vs 2.0 ± 0.5; p <0.05) and subvalvular apparatus (2.6 ± 0.5 vs 1.9 ± 0.4; p <0.001) were also higher in the MR group. Using a total score of ≥10 as a cut-off point for predicting severe MR with the Inoue technique, a sensitivity of 82%, specificity of 91%, accuracy of 90%, and negative predictive value of 97% were obtained. Stepwise logistic regression analysis identified the MR-echo score as the only independent predictor for developing severe MR with the Inoue technique (p <0.0001). Thus, the MR-echo score can also predict the development of severe MR following mitral balloon valvuloplasty using the Inoue technique.