Three-Dimensional Echocardiographic Assessment of Mitral Annular Physiology in Patients With Degenerative Mitral Valve Regurgitation Undergoing Surgical Repair: Comparison between Early- and Late-Stage Severe Mitral Regurgitation.

•Ventricular-annular decoupling is thought to exist in all degenerative severe MR.•Mitral annular saddle shape was compared between early- and late-stage severe MR.•Ventricular-annular decoupling seen in late-severe MR is absent in early-stage MR.•Surgery in early-stage severe MR preserves mitral annular function.•3D TEE provides full mitral annular evaluation which is beyond 2D parameters.