Echocardiography has played a critical role in the progress in mitral valve reconstructive surgery which was revolutionized as ''the French correction'' by Alain Carpentier in the mid 1980s. Mitral regurgitation (MR) is the most challenging valvular heart disease throughout the world and is related to rheumatic etiology in the underdeveloped world and to degenerative etiology in the Western world. Echocardiography plays an integral role in the management of patients with significant MR. This includes evaluation and follow-up during the medical management phase of MR to intraoperative mitral valve repair and post operative follow-up, using a combination of transthoracic echocardiography and transesophageal echocardiography. Newer developments include evaluation by transthoracic and transesophageal three-dimensional echocardiography. This review summarizes role of echocardiography in diagnosis, therapy and follow-up of patients with clinically significant MR. Discussion will focus on mitral valve repair for degenerative MR of myxomatous etiology and functional and ischemic MR.