Introduction: The mitral insufficiency is the most frequent cardiac valvulopathy. There are many types of investigations that can lead to a diagnosis and identify the mechanism and the etiology, such as echocardiography, a current exploration pertaining to the paraclinical examination. Featuring multiple advantages, as it is simple, fast, and non-invasive, it comes with reduced costs and it can be easily performed at the ill person’s bedside, the technique can be used to quantify the severity of the valvular lesion and to assess the hemodynamic repercussions. The purpose of this study was to assess the role of cardiac echography when it comes to the objectivization of the parameters required to establish the best therapeutic option for the mitral insuffi ciency. Methods: The study was conducted on 194 patients, having the average age of 56 ± 28.7, each having been diagnosed with severe mitral insuffi ciency and having been hospitalized between January 2010 and March 2014. The transthoracic echography that was performed on all of the patients proved to be an important method for evaluating the etiology and for quantifying the severity of the mitral regurgitation. Some of the patients (38.4%) also got the transesophageal echography. Additionally, the patients’ comorbidities were also taken into account and the preoperative balance was performed, so as to determine the best moment for surgical correction and the therapeutic option (biological or mechanical prosthesis, plasty or conservator treatment). Results: Out of the 194 patients, 122 of them (accounting for 62.8%) were in atrial fibrillation, whereas the rest of 72 (37.2%) had sinus rhythm. The mitral regurgitation was performed mostly through mitral valve annular dilatation/damaged tissue chords (63.8%), through mitral valve prolapse (24.5%) and through mitral leaflet restriction (11.7 %). The etiology was represented mainly by the prolapse of the mitral valve (36.2%). The EuroSCORE value ranged between 1.07% and 27.45%, featuring an average of 6.76%. Th e therapeutic option was best correlated with the mechanism of the mitral regurgitation (r = 0.98, p = 0.001) and with the EuroSCORE value (r = 0.54, p = 0.001). Furthermore, the volume of the left atrium was correlated with the presence of atrial fibrillation (r = 0.67, p = 0.001). Conclusions: The transthoracic echography and especially the transesophageal echography provide optimum parameters for establishing the correct type of treatment when dealing with severe mitral regurgitation and they help determine the ideal moment for surgical correction.