Background Percutaneous balloon mitral valvuloplasty (PBMV) is the standard non-surgical treatment of rheumatic mitral stenosis (MS). The success of PBMV depends on achieving higher mitral valve area (MVA) with commissural splitting. The direction of major force is an important determinant of PBMV outcome. Single balloon direct the major force toward the leaflet while double balloon technique direct the force toward the commissures. Objectives To test the hypothesis that stepwise dilation of mitral valve using single followed by double balloons (Bonhoeffer multi-track system) inflations would gradually apply bidirectional forces and hence yield better outcome. Methods Six hundred and twenty-four patients with symptomatic MS were prospectively randomized to either standard multi-track PBMV (group I: 381 pts had simultaneous inflation of two equal size balloons), or new modified technique (group II: 243 pts had stepwise dilation using single 20 mm balloon inflation followed by double balloon inflation, i.e., 20 + 16, 18, or 20 mm to body surface area). Results Both groups had comparable basic data: mean age (19.03 ± 6.44 vs. 18.62 ± 6.24 years), male/female ratio (70/311 vs. 32/211), echo score (6.18 ± 1.29 vs. 6.32 ± 1.38), MVA (0.82 ± 0.18 vs. 0.84 ± 0.12 cm 2 ), and trans-mitral gradient (26.94 ± 6.19 vs. 27.41 ± 7.13 mmHg). They had similar success rates (96.8% vs. 95.9%). Modified technique achieved significantly higher MVA (2.19 ± 0.34 vs. 1.87 ± 0.96 cm 2 , p = 0.0001) with more opened commissures (65% vs. 49.1%, p = 0.0001), and less mitral regurgitation (30/243 vs. 77/381, p = 0.011). In long term follow up, modified technique had significant lower restenosis rate (9.46% vs. 23.88%, p = 0.0001), redo surgery (2.88% vs. 7.34%, p = 0.029), and mitral valve area gain loss (0.09 ± 0.04 vs. 0.27 ± 0.06 cm 2 , p = 0.0001). Kaplan–Meier curve revealed no differences (hazard ratio = 1.04, 95% CI = 0.53 ± 2.01, p = 0.901) of total events (death, perforation, thrombo-embolism, atria-fibrillation, and large ASD). Conclusions This study demonstrates the benefits of applying bidirectional stepwise forces using modified multi-track technique which resulted into higher post dilation valve areas, less incidence of mitral regurgitation and lower long term restenosis rate.