Clinical pictures and prognosis in 24 patients (nine males, 15 females) with mitral valve prolapse (MVP) aged 60 years and older were examined at our institution. Valvular redundancy was noted in seven (29%) of the 24 patients. During a follow-up period of 38 +/- 18 months, four patients had mitral valve replacement and one died of congestive heart failure due to severe mitral regurgitation (MR). There was no episode of embolism or sudden death. Among 80 patients (47 males, 33 females) with MVP aged 60 years and older at St. George's Hospital in England, on the other hand, valvular redundancy was noted in 49 (61%) of 80 patients. During the same follow-up period of 39 +/- 28 months, 18 patients underwent surgery and seven patients died of heart failure (31%). There were 11 patients who had embolism (14%), but no sudden death. Although there was no significant difference in the incidence of severe MR in these two groups, valvular redundancy and embolism were less frequent in Japanese patients at our institution than the English patients in St. George's Hospital. These differences should be taken into consideration when one evaluates clinical profiles and prognosis of elderly MVP patients.