Reconstructive surgery for ischemic MR(IMR) must rely on the morphological basis of the mitral apparatus. The aim of the study was to recognize the differences of the mitral valve (MV) geometry and the consequent MR jet pattern in IMR patients according to the contributing LV geometry. Method: Thirty three IMR patients underwent real-time 3D echocardiography. IMR patients were divided into two groups according to the contributing LV geometry; regional IMR (n=16) followed by localized posterior wall remodeling due to posterior infarction, global IMR (n=17) followed by global LV remodeling due to severe LV systolic dysfunction. MR severity was quantified by regurgitant volume (RV) using PISA method. Using multi-planar reconstructive (MPR) mode, two antero-posterior (AP) planes were generated for imaging the medial and lateral side of the MV during mid-systole. In two AP planes, MV tent area (MVTa) and the angles between annular plane and each leaflet (anterior: A慣, posterior: P慣) were measured. Results: LV chamber (LVEDD: 193짹42 vs. 136짹26 ml, p<0.01) was significantly larger and systolic function (EF: 28짹6 vs.38짹7 %, p<0.01) was significantly lower in global IMR than regional IMR. There was no significant difference of RV between two groups (30짹15 vs. 35짹14 ml, p>0.05). Eccentric posterior MR jet was observed in fourteen patients in regional IMR but in one patient in global IMR. In global IMR, A慣, P慣 and cMVTa showed no significant (p> 0.05) difference from the medial to lateral side of the MV, while in regional IMR, A慣 (32짹8 vs. 22짹8째, p<0.01) and cMVTa (0.84짹0.23 vs. 0.56짹0.17 cm짼/m, p<0.01) (corrected MVTa by the height of the patient) were significantly smaller in the lateral side of the MV. Conclusion: The characteristic MR jet (eccentric posterior jet) observed in regional IMR was found to be attributed to the different MV deformation from that in global IMR. Our findings may suggest different strategies of surgical treatment for these two different types of ischemic MR.