Ischaemic mitral insufficiency (IMI) due to regurgitation of an anatomically normal valve, due to dysfunction directly related to myocardial ischaemia, is observed in over 20% of post-infarction patients and is associated with a doubling of the risk of death. The responsibility of ventricular remodelling with displacement of the papillary muscles in the genesis of IMI has been demonstrated experimentally. 3-D echocardiography has improved our understanding of the central role of geometrical changes of the subvalvular apparatus. The inconsistent results of surgery using an undersized mitral annulus have led to the search for alternative techniques. The correction of mitral insufficiency at coronary bypass surgery is a current topic of research. The application of new techniques of mitral valvuloplasty seems more effective and should provide an answer to this problem.