The mitral valve apparatus, both functionally and morphologically is composed of a constellation of individual structures, including the annulus, anterior and posterior leaflets, chordae tendineae, and papillary muscles. Most also include the left ventricular wall and the left atrium which are essential for the valve to function normally. Areas covered: The commonest conditions responsible for mitral valve dysfunction in the Western World are degenerative and functional mitral regurgitation, which are discussed in detail. Treatment strategies in patients at high surgical risk are rapidly evolving, as more options for transcatheter mitral valve repair and replacement become available. Expert commentary: Although surgery remains the gold standard, many elderly patients with severe comorbidities need intervention as surgery may no longer be an option. Today, transcatheter mitral valve therapies are in their infancy but with advances in technology they will likely become tomorrow's therapy. The heart team plays an important role, discussing and addressing individualized strategies for each patient. However, a thorough knowledge and the understanding of mitral valve anatomy, pathology, and clinical assessment is mandatory in order to choose the best treatment possible.
Keywords: MitraClip; Mitral valve; Transcatheter mitral valve repair; degenerative MR; functional MR; mitral valve regurgitation; mitral valve repair; mitral valve replacement; mitral valve stenosis; primary MR; transcatheter mitral valve replacement (TMVR).