Interventional treatment of mitral insufficiency has recently become possible on a limited basis. The developed percutaneous procedures aim at minimizing the trauma in high-risk surgical candidates. Echocardiography has a major role in the preinterventional evaluation, during the interventional procedure, and in the postinterventional follow-up. The preinterventional analysis is focused on the assessment of valvular morphology and mitral insufficiency severity. This allows definition of patients potentially treatable by percutaneous therapy as well as the most suitable interventional approach. During interventional treatment, echocardiography is used as the integral tool to guide the procedure and for immediate assessment of the obtained therapeutic effect. Immediately post intervention, echocardiography should be performed to define the obtained status, allowing detection of subsequent changes in left ventricular function and mitral insufficiency severity.