A 68-year-old woman had mitral valve regurgitation due to a P2 prolapse. Her left ventricular ejection fraction was preserved, but she had pulmonary hypertension (pulmonary artery pressure > 65 mm Hg) and dyspnea (New York Heart Association [NYHA] class II to III). Therefore, she underwent surgery with a quadrangular resection of the P2 prolapse, and a mitral ring was implanted. After surgery, her symptoms did not remarkably improve. She still had dyspnea NYHA II-III. Six months after surgery, a transthoracic echocardiogram revealed severe mitral regurgitation, and a transesophageal echocardiogram (TEE) was done to define the etiology of the mitral regurgitation more precisely. The images (Videos 57-1 to 57-5 and Figs. 57-1, 57-2, 57-3, 57-4, 57-5, 57-6, 57-7 and 57-8) show the postsurgical echocardiogram findings.