The study aims were to evaluate: (i) the clinical presentation in a consecutive series of 152 patients with myxomatous mitral valve prolapse undergoing surgical repair; (ii) the correlation between pre- and intraoperative echocardiographic features and surgical findings in these patients; and (iii) whether clinical and echocardiographic data may predict the surgical outcome. The majority of patients with myxomatous mitral valve prolapse and severe regurgitation undergoing valve repair has chordal rupture of the posterior mitral leaflet, a condition in which results of valve repair are excellent. TEE provides a powerful means to define the mechanisms of mitral regurgitation and to identify the suitability of patients for valvuloplasty.