Objective: Mitral valve repair in rheumatic patients is still a challenge. The aim of this study is to assess the results of mitral valve repair in rheumatic patients with rheumatic mitral insufficiency.Methods: 330 patients with rheumatic mitral insufficiency who had undergone mitral valve repair in the Heart Institute HC-FMUSP were assessed retrospectively, between 1985 and 2005. The mean age was 26.9 ± 15.4 years and 57.6% were female. On preoperative assessment, 39.5% of patients were in NYHA functional class IV. The most common techniques for repair employed were bovine pericardial strip annuloplasty in 48.4% patients and Carpentier ring annuloplasty in 22.6%. Shortening of chordae (20%) and papillary muscle splitting (17.8%) were the most common associated techniques performed. Tricuspid valve repair (26.7%) and aortic valve replacement (27.2%) were the most common associated procedures.Results: The hospital mortality was 0.9% (three patients), two of them children with active rheumatic fever. Linearized rates of thromboembolism, endocarditis, reoperation and late death were 0.2%, 0.2%, 3.5% and 0.5% patients-year, respectively. Actuarial survival in 20 years was 86.4 ± 6.6%.