Abstract: We report the 20 year follow up of a female patient who underwent mitral valve billowing and prolapse (Barlow) repair at the age of 29 yrs. Our repair method to aggressively remodel the valve, which maximizes predictable anatomic and physiologic efficacy and minimizes unpredictable results incorporates a complete resection of the posterior leaflet, a sliding and folding plasty with the remaining lateral scallops combined with a triangular resection of the anterior leaflet and a ring-annuloplasty. This long term follow up confirms the absence of any sclerotic leaflet degeneration or calcification, a perfect leaflet coaptation and no regurgitation with normal ventricular function in regular sinus rhythm after 20 years.Abstract: We report the 20 year follow up of a female patient who underwent mitral valve billowing and prolapse (Barlow) repair at the age of 29 yrs. Our repair method to aggressively remodel the valve, which maximizes predictable anatomic and physiologic efficacy and minimizes unpredictable results incorporates a complete resection of the posterior leaflet,...Show More