Schema of enhanced stay sutures (ESS). Mitral valve leaflet and medial site of anterior leaflet is elongated and prolapsed. (a) Horizontal mattress sutures (3–0 polyester suture with pledgets) for anterior and posterior commissures. Stitches pulled bigger bites out of posterior annular side. (b) After ESS. Anterior and posterior commissures are compressed and coaptation is deeper. ESS allowed not only deeper coaptation, but also pulled posterior leaflet upwards to the same plane as anterior leaflet by taking bigger bites out of the posterior annular side. This also rendered prolapse sites highly visible.