Repair of the prolapsing anterior leaflet (AML) in degenerative mitral valve disease is more demanding than that of the posterior leaflet. We reviewed our experience in the past eight years, to examine the safety, efficacy and stability of various repair artifices. Between January 1989 and December 1997, 102 patients (mean age 64 years) with mitral regurgitation (MR) due to prolapse of the anterior or both mitral leaflets underwent mitral valve repair. Sixty-six patients were in NYHA class >III; 94 had MR grade >II. Acute endocarditis was seen in 12 patients and Barlow disease in 16. Surgical techniques included chordal shortening, chordal transposition, papillary muscle shortening or plication, flip-over and artificial chordae implantation. There was no early mortality. Mean follow up was 30 months. There were four late deaths. Five patients had mitral valve replacement between four and 32 months later: one for mitral stenosis due to posterior leaflet calcification, and four for recurrent MR. One patient suffered bacterial endocarditis which was treated medically. Of 92 remaining patients with valve repair, 81 are currently asymptomatic, five are in NYHA class II and four in class III. Transesophageal echocardiography (n = 76) at a mean of 30 months after surgery showed no MR in 68 patients, and MR of grade >II in three. In conclusion, AML prolapse repair is safe and durable, and thus can be attempted even in mildly symptomatic patients. However, chordal shortening should be substituted by implantation of artificial chordae or by flip-over technique.