Objective To explore the short-term effects of mitral valvuloplasty and mitral valve replacement for rheumatic mitral valve lesions. Methods A total of 400 patients with rheumatic mitral valve lesions admitted from July 2019 to June 2023 were selected as study subjects and divided into two groups， including 200 cases with mitral valvuloplasty （study group） and 200 cases with mitral valve replacement （control group）. The cardiac function， surgical indexes， hospital stay， mitral regurgitation， and complications were compared between the two groups. Results The preoperative left ventricular end-diastolic diameter （LVEDD）， left ventricular end-systolic diameter （LVESD）， left ventricular ejection fraction （LVEF）， and left atrial diameter （LAD） of the study group did not differ from those of the control group （P>0.05）， and the postoperative indicators of the study group were higher than those of control group （P<0.05）. The amount of intraoperative bleeding and hospitalization time of the study group were less than those of the control group， but the duration of extracorporeal circulation and the duration of operation of the study group were longer than those of the control group （P<0.05）. Moderate mitral regurgitation occurred in 3 cases and mild mitral regurgitation in 15 cases in the study group， and the incidence rate of mitral regurgitation of the study group was lower than that of the control group （P<0.05）. The rate of complications of the study group was lower than that of the control group （P<0.05）. Conclusion Mitral valvuloplasty is more effective in the treatment of rheumatic mitral valve lesions than mitral valve replacement by facilitating recovery with high safety and obviously improved cardiac function， and is worthy of clinical promotion.