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Mitral valve (MV) repair is the preferential treatment for mitral regurgitation (MR) associated with degenerative MV disease, and the functional benefits of early surgery are known. Our goal was to evaluate the changes in LV shape following MV repair, using a new method based on real-time 3D echocardiography (RT3DE). Fifty patients with severe asymptomatic MR were enrolled. Transthoracic RT3DE imaging was performed the day before, 6 and 12 months after MV repair. A group of 66 normal subjects (NL) was studied as a reference. LV 3D shape indices of sphericity (S) and conicity (C) were computed. Post-operatively, LV volumes were decreased compared to pre-surgical values. EF was slightly decreased 6 months after surgery, but restored at 12 months. Modifications in end-diastolic LV shape were found: prior to surgery, S was elevated and C was decreased compared to NL; at 6 months, these changes were reversed with no further improvement at 12 months. Early MV repair in asymptomatic patients is associated with changes in LV shape which remodels to near normal morphology. Novel 3D shape analysis based on RT3DE, allows serial examination of the complex relationship between LV performance and shape.