Mitral regurgitation (MR) is the most frequent valvular disease in industrialised countries. MR is classified as primary (mostly degenerative with valve prolapse) or secondary (mainly due to underlying ischemic heart disease resulting in deformation of the valve structure). Surgical repair represents the optimal treatment for severe primary MR, whereas the benefits of surgical correction of secondary MR are controversial. Over the past few years, transcatheter techniques have been developed to treat MR, such as the percutaneous edge-to-edge procedure (MitraClip). These approaches represent a novel therapeutic choice for patients judged inoperable by the "heart team". This review article aims to summarize the principles of MR assessment and discuss current therapeutic options for severe MR, taking into account the latest advances in the field.