Valve analysis should integrate the assessment of the aetiology, the lesion process and the type of dysfunction. The distinction between a primary and a secondary cause of MR is mandatory. The diameter of the mitral annulus, the lealfet involved in the disease process and the associated valvular lesions should be carefully described in the final report.

• TTE is recommended as the first-line imaging modality for mitral valve analysis.
• TEE is advocated when TTE is of non-diagnostic value or when further diagnostic refinement is required.
• 3D-TEE or TTE is reasonable to provide additionnal information in patients with complex mitral valve lesion.
• TEE is not indicated in patients with a good-quality TTE except in the operating room when a mitral valve surgery is performed.