With the aging of society, mitral valve insufficiency due to degenerative lesions has become the most common valvular heart disease today. There is a consensus that symptomatic severe mitral insufficiency should undergo surgery as early as possible; however, due to the lack of large-scale prospective randomized double-blind clinical trials, the optimal treatment for asymptomatic patients with severe mitral insufficiency is still controversial, with those who advocate surgery suggesting early prophylactic prosthetic repair and plasty, and those who are against it suggesting that medication should be used for close follow-up and surgery should be performed with caution. In recent years, the progress of research has been synthesized, asymptomatic severe mitral valve insufficiency is suitable for early surgery in the following cases: (1) left ventricular ejection fraction of 30-60%, or left ventricular end-systolic diameter of ≥40 mm; (2) left ventricular function is normal, but the mitral regurgitant area is ≥40 mm2; (3) left ventricular function is normal but atrial fibrillation is present; (4) left ventricular function is normal, but the emergence of pulmonary hypertension (resting pulmonary systolic pressure), and the presence of pulmonary hypertension. (pulmonary artery systolic pressure >50 mm Hg at rest or >60 mm Hg after exercise); (5) normal left ventricular size with plasma natriuretic natriuretic peptide B ≥31 pg/ml; and (6) normal left ventricular size with a cardiorespiratory reserve less than 84% of the expected value for the same age and sex. Other asymptomatic severe mitral valve closure insufficiency can be observed with close follow-up. Close follow-up consists of clinical and ultrasound visits at least once a year, and after the initial evaluation of the patient’s degree of mitral regurgitation, it is recommended that the patient be followed up every 3 to 6 months initially to obtain more stable information about the patient. The follow-up interval should be shortened if the patient’s follow-up changes from previous data or if the data are close to the surgical index. High-quality ultrasound imaging data such as mitral regurgitation area determination for regurgitation quantification is the focus of follow-up, as opposed to determination of ventricular size and left ventricular ejection fraction. Setting a certain activity level for patients according to age and gender can also help to detect new symptoms, as patients may voluntarily reduce their activity level to avoid post-exercise shortness of breath, presenting a so-called asymptomatic state that masks the condition.