Mitral valve insufficiency is roughly classified as a result of annular enlargement and leaflet lesions or papillary muscle lesions. For mitral annular enlargement, we usually use annuloplasty, either direct annuloplasty of the posterior annulus or artificially shaped annuloplasty, which is more uniform and has better long-term results. The treatment of incomplete closure due to leaflet lesions is not complicated, with the posterior leaflet lesions being simpler and can be treated by wedge resection of the regurgitant site alone, with the resected edge counterclosed and annuloplasty of the annulus. Anterior leaflet lesions are more difficult because the anterior leaflet is the main functional part of the mitral valve, and the surgical approach should be tailored to the cause of anterior leaflet regurgitation. The current approach is to preserve the entire anterior valve and add one or more artificial tendons to the regurgitation site to reduce regurgitation. If the lesion is complex, a combination of tenon shortening, tenon transfer, or double orifice plication methods can be used. Mitral valvuloplasty has more advantages than mitral valve replacement, most notably reducing postoperative complications and anticoagulation complications, and is still preferred if it can be performed in patients. However, the degree of valvular disease required for valvuloplasty is relatively high, and the best is for mitral valve insufficiency with moderate mitral valve closure or higher, combined with mild stenosis can also be considered, but severe stenosis may be minimized by valvuloplasty. The benefit of valvuloplasty for mitral regurgitation below moderate level is not great and can be observed at regular follow-ups without the need for urgent surgery.