Abstract In young patients with rheumatic mitral regurgitation (MR), valve repair is more desirable than prosthetic valve replacement. This is particularly true in developing countries where anticoagulation with warfarin is difficult to monitor, and also in women of childbearing potential in whom warfarin is relatively contraindicated. The durability of repair in rheumatic MR may not be as good as in myxomatous disease. 1–4 The explanation for the less satisfactory results of repair in rheumatic than degenerative disease has not been clearly defined, but could be due to either a worse initial outcome owing to extensive valvular disease, or to ongoing rheumatic activity that damages an initially good result. This study examines retrospectively the morphologic patterns present in patients undergoing mitral valve repair and subsequent reoperation for recurrent or ongoing valve dysfunction.