This report summarizes the mid-term results of 22 patients (mean age 46 years, mean follow up 46 months) who required mitral valve reconstruction as a result of acute endocarditis. Over 70% of patients had severe mitral regurgitation and were in NYHA functional class III. Surgical techniques included annuloplasty, suture and patch closure of the perforation, leaflet resection and chordal transfer. Additional surgery included coronary artery bypass grafting, De Vega plasty, and aortic valve replacement or reconstruction. Two patients died perioperatively. At the last follow up, 15 patients were in NYHA class I and five in class II; no or only mild mitral insufficiency was seen on transthoracic echocardiography. Estimated survival rate at 60 months was 87 ± 12.7%. No incidence of recurrent valve infection occurred. On this basis, mitral valve reconstruction for mitral insufficiency secondary to AE may be recommended as a valve salvage treatment, when it is technically possible.