I am presenting a review of some cases of left ventricular rupture in Mansoura university Hospitals;Egypt and King Faisal Specialist Hospital and Research Centre; Jeddah;Saudi Arabia. I referred to some international experiences published in that field especially the New York University experience to reduce the left ventricular tear during mitral valve surgery. I presented the incidences, aetiology, pathogenesis, 5 different types of ruptures, diagnosis and presentation and some basic for successful repair of the tear which may be closure of the full extent of the tear, placement of sutures into healthy myocardium and not into the injured oedematous tissue in the immediate vicinity of the tear, and sparing the left circumflex coronary artery and its major marginal branches, removal of the prostehesis and accurate identification of the site of tear. All repairs should be done on Cardiopulmonary bypass. The difficulties of the different methods of treatment are presented in details. I described internal and external approach, auto-transplantations and a new algorithm of management.