Functional mitral regurgitation( FMR) is a risk factor that increases the mortality rate and incidence of heart failure. Surgical intervention is important. Mitral valve (MV) reconstruction can preserve the valvular apparatus;no anticoagulation therapy is required, left ventricular function is preserved. Some studies have reported a high mitral regurgitation (MR) recurrence rate with only restrictive MV annuloplasty for FMR. Therefore, various reconstructive techniques for FMR have been developed. Papillary heads optimization( PHO),reported by Komeda, is one technique. We performed MV repair with the PHO technique in 3 FMR cases. The 1st case had severe tethering and annulus dilatation due to chronic MR, the 2nd and 3rd were caused by ischemic and dilated cardiomyopathy (DCM),respectively. In the early postoperative period, we achieved technical success in all cases. However, 9 months later, moderate MR had recurred in the 3rd case. Geometric measurements with transthoracic echocardiography showed an increase of the papillary muscle distance between the papillary muscle origin and the posterior MV anuulus. The correction of papillary muscles position by PHO might have failed by the progress of DCM, and MR recurred. The operative method and indication for DCM should be carefully considered.