Abstract Background: There is no consensus regarding the selection criteria for the annuloplasty rings, although some publications have addressed this issue. Usually, complete rigid rings are preferred to treat functional MR, under-sizing the prosthesis to overcome leaflet tethering, while flexible or semirigid rings, either complete or partial, are more often used to treat degenerative. Aim of Study: Evaluation of the mitral valve competency and gradient after mitral valve repair comparing rigid annu-loplasty ring vs flat physio II ring. Patients and Methods: Between October 2018 and October 2021, thirty-three (33) patients underwent mitral valve repair by flat physio ring and saddle shaped annuloplasty ring for degenerative and ischemic mitral valve disease respectively. Correlation between postoperative mitral hemodynamics was evaluated, the ischemic patients were fully revascularized. Results: Only (2) patients had a significant MR from the degenerative by using flat physio II ring while 3 patients developed a significant increase in mean Diastolic Gradient on the mitral valve. Conclusion: Selection of mitral valve ring should be differ according to the type of the pathology.