Medical management of acute mitral regurgitation (MR) prioritizes the alleviation of pulmonary congestion via intravenous diuretic administration and, if necessary, mechanical ventilation. Afterload reduction with vasodilator agents, such as nitroprusside or nitro-glycerine, can mitigate regurgitant volume; however, their application is frequently constrained by systemic hypotension. Vasoactive agents (e.g., norepinephrine or dopamine) may be required to maintain haemodynamic stability. In cases of progression to cardiogenic shock (CS), mechanical circulatory support (MCS), including intra-aortic balloon pump (IABP), transaortic microaxial pump, or venoarterial extracorporeal membrane oxygenation (VA-ECMO), may be indicated. Nevertheless, mitral valve (MV) intervention remains crucial, particularly in emergent scenarios. Surgical repair or replacement has historically been the standard of care for acute MR, however, the advancements in transcatheter edge-to-edge repair (TEER) therapies, Table 1, provide alternative treatment strategies, especially for patients deemed high-risk for conventional surgery, Fig. 1 [2]. (See Central illustration.)