Valve repair is an established form of treatment for mitral valve regurgitation. In order to elucidate the feasibility and results of aggressive repair in a young rheumatic population, all consecutive patients operated on between July 1988 and July 1990 for mitral regurgitation were reviewed. There were 203 patients with a mean age of 29 years; 91% were in functional classes III-IV. Pure regurgitation was present in 47.8%. Associated valvular surgery was performed in 56.2%. Forty-nine (24.1%) patients had a straight valve replacement (MVR), 18 (8.9%) had an unsuccessful attempt at repair and in 136 (67%) the repair was considered successful. Overall hospital mortality was 3.4%: 4% for MVR, 16.6% for the attempts, 1.4% for repairs. The thromboembolic rate for replacement was 6.0% pt-yr and for repair 0.87% pt-yr. There were five late deaths in the replacement group and one in the repair group. Seventeen patients required reoperation in the repair group (12.6%) with a mean age of 17 years. Six of these patients had active rheumatic carditis, either at first operation or in the postoperative period. The postoperative functional status of all patients was excellent. In conclusion, valve repair although possible in a high percentage of rheumatic regurgitation patients carried a penalty of unsuccessful attempts and reoperations. However, in the follow-up period the rate of thromboembolism and late mortality among the patients with prostheses offsets these disadvantages.