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Background: This study evaluate the 3D anatomy of MV undergoing mitral repair.Methods: Thirty patients (16 men, 54±13.9) with severe MR (8 PL prolapse, 14 AL prolapse, and 8 BL prolapse) and 20 control (14 men, 58.8±7.4)were studied. All patients underwent MV repair. RT3D-TEE was performed before and immediate after surgery. Quantitative 3D anatomic analysis of the MV was performed offline using dedicated software.Results: There were variations in the 3D geometry of the mitral annulus, leaflets, and subvalvular apparatus among MR and compared to control (Table). Prolapse volume was significantly decreased (0.5±0.6 to 0.003±+0.01mL, P<0.001). Multiple linear regression analysis, angle of AL (HR -0.44,p=0.019) and non-planar angle of leaflets (HR 0.47, p=0.013) predict post OP MV mean PG.Conclusions: Successful MV repair is universally characterized by significant surgical modification of the MV anatomy that results in prolapse elimination and subannular coaptation. RT3D-TEE provides new insights that allow the refining of mitral pathophysiology concepts.