OBJECTIVE Techniques of mitral valve replacement with leaflet and chordal preservation normally involve the use of a bioprosthesis or bileaflet valve to reduce the risk of obstruction of the prosthesis by the retained subvalvular apparatus. METHODS The technique of mitral valve replacement with the Monostrut prosthesis and with preservation of the posterior leaflet is described. The stitches are placed in such a manner that the posterior leaflet is folded under the posterior aspect of the prosthetic ring. CONCLUSIONS The technique allows safe implantation of the Monostrut valve. The excellent performance of this prosthesis can be therefore combined with the beneficial effects of chordal preservation on left ventricular function.