Functional mitral regurgitation (MR) is a frequent complication of systolic heart failure resulting from left ventricular remodeling and apical dispacement of the coaptation point. Functional MR is associated with an increased mortality. It is characteristically dynamic. The dynamic component can be assessed and quantified by exercise Doppler echocardiography and has clinical and prognostic implications. Several therapeutic modalities can be used in the management of functional MR. Optimal medical treatment is mandatory. Selected patients are improved by cardiac resynchronization therapy. Mitral valve repair--undersized annuloplasty--can be useful but the indications are still controversial. Percutaneous annul loplasty is feasible. The first implantation in the world of one of the devices has been performed in CHU Liège.