Echocardiographic examination plays an extremely important role in mitral valve repair surgery. Three-dimensional (3D) transesophageal echocardiography allows us to examine the valve morphology with ‘en-face’ view of the mitral valve from the surgeon’s view. 3D geometry of the mitral valve and mitral valve complex can be quantitatively measured by using 3D volumetric data, which has been impossible with two-dimensional (2D) echocardiography. Perioperative diagnosis including preoperative/intraoperative/postoperative diagnosis by echocardiologists is essential to achieve successful repair surgery. In this review, the role of echocardiography and the noninvasive cardiologist in the management of mitral valve repair surgery is summarized.