Mitral regurgitation (MR) is the second most frequent valvular disease following aortic stenosis. Patients with severe MR who are managed conservatively sustain an excess mortality and morbidity. It leads gradually to the impairment of the left ventricular function and to the decline of survival even after the surgery. Nowadays the majority of patients can undergo mitral valve repairment. With improved mortality and morbidity rates being achieved, cardiologists and cardiac surgeons are becoming more aggressive in treating patients with severe MR with surgery. Recent data indicate that even in the absence of symptoms or left ventricular dysfunction, surgery should be offered as a treatment for MR, provided that the regurgitation is severe, the valve seems to be repairable, the surgeon is experienced in valve repair and is aided by intraoperative transesophageal echocardiography.