Mitral regurgitation in Barlow disease may still be challenging to be repaired . Most often it involves the posterior leaflet . Many techniques and concepts are currently available ; the main goal being to restore a good surface of coaptation . Basic principles such a thorough analysis is still required whatever the approach to assess excess tissue height , width and prolapse . Nowadays it seems that two different ways of treating mitral prolapse coexist : the non resection one and the resection one .Both will be discussed and analysed . Similarly the use of artificial chordae seem to have a preponderant role to support the free edge and correct a prolapse . Native secondary chord transfer are easy and reliable but seem abandoned by many . Anterior leaflet prolapse is also dealt with and fewer options are available to address this leaflet . Then commissural prolapse is mentioned . It is an important area of the valve which should deserve better treatment than commissuroplasty . Finally a special entity will be described ; mitro annular disjonction . The approach is not or no longer an issue as only good long term results are important in an era where per cutaneous therapy is the only non invasive technique .