Mitral valve diseases are common causes of congestive heart failure. Chronic primary and secondary (functional) mitral valve regurgitation are the most common reasons. Valve repair for primary mitral regurgitation cures mitral valve disease, whereas in functional regurgitation, mitral valve repair is associated with high failure rates secondary to persistent/progressive ventricular dysfunction and remodeling. Most patients are managed with strict adherence to the valve guidelines. Mitral valve replacement has an increased role in management of functional mitral regurgitation. Surgery for mitral valve disease is indicated in symptomatic patients with severe valve disease and in asymptotic before irreversible ventricular damage occurs.