Various rings are available to achieve more physiologic mitral valve repair from viewpoints of physiologic mitral annular structure or dynamics. We evaluated preoperative and postoperative mitral annular structures and dynamics.Thirty-six patients underwent mitral valve repair for degenerative mitral insufficiency. Carpentier-Edwards Physio II ring (semirigid [Edwards Lifesciences, Irvine, CA]), St. Jude Medical Rigid Saddle Ring (RSR [St. Jude Medical, St. Paul, MN]), and MEMO 3D ring (semirigid [Sorin SpA, Milan, Italy]) were implanted in 13, 12, and 11 patients, respectively. Intraoperative real-time three-dimensional transesophageal echocardiography was performed before and after repair.The postoperative anteroposterior diameter reduction rate from end diastole to end systole was significantly (p < 0.0001) larger in MEMO (9.58% ± 2.91%) than in Physio II (0.98% ± 1.04%) and RSR (1.94% ± 1.95%). There were no significant differences in the commissure-to-commissure diameter reduction rates among the groups: 0.81% ± 1.98% for Physio II, 0.12% ± 0.53% for RSR, and 0.51% ± 1.98% for MEMO. The postoperative end-systolic annular height commissure width ratio was significantly (p < 0.0001) larger in both Physio II (17.9% ± 3.0%) and RSR (18.5% ± 1.6%) than in MEMO (13.6% ± 3.0%). The postoperative annular height commissure width ratio increase rate from end diastole to end systole was significantly larger in MEMO (5.1% ± 2.3%) than in Physio II (0.1% ± 0.6%) and RSR (0.3% ± 0.5%).Physio II and RSR could restore the physiologic three-dimensional annular shape, but the annular motion was diminished. Conversely, MEMO could preserve both the anteroposterior movement and folding dynamics, but no three-dimensional restoration of the mitral annulus was obtained.