Between January 1981 and November 1994, 64 patients underwent reconstructive surgery for mitral valve regurgitation (MR). The ages of the patients ranged from 18 to 71 years (52.8 +/- 8.9). Pathological causes of regurgitation were degenerative in 41 (64%), infective endocarditis in 9 (14%), rheumatic in 8 (13%) and ischemic in 6 (9%). In 27 patients, Kay's and Reed's methods were performed for prolapsed valve and enlarged annuls. In 23 patients who had ruptured chordae of the anterior leaflet in 3, posterior leaflet in 17 and both anterior and posterior in 3, McGoon's method was performed. Ten patients, who had elogated chordae or ruptured papillary muscle, were repaired with GORE-TEX sutures. Cleft repair with sutures and leaflet repair with autopericardium patch was done in 4 patients. There was no hospital death, but one late death. With the follow-up interval from 2 to 155 (mean 63.2) months after surgery, the incidences of freedom from reoperation were 94.8% after McGoon procedure, 89.7% after Kay and Reed, 88.9% after chordaplasty and 75% after cleft and patch repair. The hemodynamics and left ventricular function after McGoon repair in 15 patients revealed with significantly better outcomes than after valve replacement in 15 patients. In conclusion, optimal selection of reconstructive procedures will offer satisfied postoperative long-term results with less freedom of reoperation for MR.