Carpentier's technique for reconstructive mitral valve surgery is an alternative to mitral valve replacement in patients with mitral regurgitation. The procedure involves reconstruction of the mitral valve and insertion of a ring into the mitral anulus. To study the results of this operation, pre- and postoperative M-mode, two-dimensional (2DE), and Doppler echocardiography were performed on 13 patients with severe, symptomatic mitral regurgitation, who underwent reconstructive mitral surgery. A significant clinical improvement was noted in all patients. This correlated with the hemodynamic and angiographic improvement in six of the patients who underwent postoperative cardiac catheterization. Postoperative echocardiography showed that the mitral valve E-F slope decreased from 129 +/- 30 mm/sec preoperatively to 53 +/- 13 mm/sec postoperatively (p less than 0.001). The mitral valve excursion decreased from 28 +/- 6 mm preoperatively to 19 +/- 2 mm postoperatively. The left ventricular minor axis shortening decreased from 32 +/- 9% to 28 +/- 6%. In seven patients the mitral valve area decreased from 4.5 +/- 0.9 cm2 to 2.8 +/- 0.5 cm2 (p less than 0.005). In each patient a new echocardiographic finding was observed: two parallel dense linear echoes from the prosthetic ring were noted on M-mode echocardiography near the base of the mitral valve. 2DE visualized the entire ring. Doppler echocardiography suggested moderate or severe mitral regurgitation in eight of eight patients studied preoperatively. Postoperatively 10 of 11 patients had no Doppler echocardiography finding of mitral regurgitation.