Background ; Although many studies demonstrated the importance of preserving an mitral annulopapillary muscle continuity in mitral valve replacement (MVR), the long-term effects of complete excision of the native valve apparatus on global and regional morphological and functional changes of the left ventricle have rarely been studied in vivo. The purpose of this study was to add as a postscriptum of preserving a mitral annulopapillary muscle continuity in MVR patients for rheumatic mitral stenosis. Methods ; Total 6 patients (1 male, 5 female ; mean age 56 years) who underwent MVR with complete excision of the native valve apparatus in a mean of 15 years ago was recruited for checking a 16-slices MDCT (Group R). 6 healthy candidates matched in sex and age were also checked for control group (Control C). The changes of global and regional left ventricular morphology and function were evaluated by the single experted radiologist. Results ; Global left ventricular ejection fraction in group R was preserved relatively (44.3% ranged 38.9-50.9%). However, the contraction of the mid-ventricular wall on the vicinity of insertion of the both papillary muscle and apical wall in group R was showed a significant decline (p=0.003 on mid-ventricular wall, p=0.024 on apical wall). Additionally the mid-ventricular wall thickness in group R was also decreased compared to basal and apical portion. Conclusions ; Although the global left ventricular function after complete excision of the native valve apparatus was preserved relatively through adaptive mechanism over several years, the regional wall motion abnormalities was started on the vicinity of atrophied both papillary muscles. Furthermore this mid-ventricular contractile dysfunction caused an apical wall dysfunction. It may be an explanation for the cause of mid-ventricular rupture and contractile dysfunction after MVR without annulopaillary continuity.