The European Society of Cardiology (ESC) has issued guidelines that classify this disorder as either primary (organic) or secondary (ischaemic and functional) MR.1 In primary MR it is the valve itself which is at the origin of the problems, while in the case of secondary MR, it is the left ventricle (LV) that has sustained previous damage due to a myocardial infarction or dilated cardiomyopathy, resulting in annular dilatation and lateral displacement of the papillary muscles causing mitral valve insufficiency.1 Ischaemic MR results from a restriction of the mitral leaflets due to tethering of the subvalvular apparatus in an LV affected by ischaemia, while functional MR is secondary to changes in LV geometry resulting from LV dysfunction (as observed in idiopathic or ischaemic cardiomyopathy with severe LV dysfunction).1