A 40-year-old woman was admitted with severe mitral regurgitation (MR) and atrial fibrillation. Preoperative 3-dimensional transesophageal echocardiography demonstrated severe MR with an unruptured mitral valve aneurysm and a cleft. The stiff cleft edge was removed and closed directly, and plication of the aneurysm was added. After the implantation of a semirigid full ring, there was no residual MR. An adult patient with MR involving an unruptured mitral valve aneurysm with a cleft not associated with infection or a congenital anomaly is extremely rare. The 3-dimensional transesophageal echocardiography modality is useful for mitral valve repair because it provides precise anatomic information preoperatively.
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