It is necessary to accurately predict the feasibility of mitral valve (MV) repair using echocardiography when surgical intervention for mitral regurgitation (MR) is considered. It is also important to plan the MV repair procedures preoperatively. Before performing MV repair for primary MR as represented by degenerative MR due to MV prolapse, the feasibility of MV repair is determined by echocardiographic assessments of the location, extent, and etiology of the main lesion. The MV repair procedure, such as leaflet resection or chordal replacement, is planned according to the information on both the main lesion and the sub lesion. In patients at high risk for postoperative left ventricular (LV) outflow tract obstruction due to the systolic anterior motion of MV leaflets, some optional procedure should be performed to avoid the complication. In patients with secondary (functional) MR due to LV dysfunction, it can be predicted by the degree of MV tethering-tenting whether mitral annuloplasty alone can control the MR. On the other hand, mitral annuloplasty would be the primary treatment for atrial functional MR, the concept and etiology of which have been recently established. In conclusion, we, i.e., all of the heart team members, should understand that the morphologic diagnosis using echocardiography is the most important in determining whether MV repair is indicated and which procedure to use.