Accurate evaluation of mitral regurgitation (MR) severity remains a challenging task in clinical cardiology. The importance of proper quantification of regurgitation cannot be underestimated because a delayed decision to replace or repair a defective valve may lead to worsening ventricular function and increased perioperative and long-term mortality. In this review we discuss both recent developments in the quantification of MR as well as new insights into the pathophysiology and progression of this lesion. (C) 2001 Lippincott Williams & Wilkins, Inc.