Mitral regurgitation is the most common valvular abnormality in adults over the age of 55 years and is associated with significant morbidity and mortality [ ]. In contrast to primary mitral regurgitation which results from a defect in the leaflets themselves, functional mitral regurgitation (FMR) (also known as secondary mitral regurgitation) can be due to a variety of etiologies which distort the architecture surrounding otherwise normal mitral valve leaflets [ ]. More common causes include ischemic or nonischemic cardiomyopathy leading to left ventricular remodeling or mitral annular enlargement from left atrial dilation [ ]. As the cause of FMR varies, the potential solutions are similarly varied and should be tailored to each individual patient [ ]. Medical therapy is the foundation of treatment regardless of etiology as some patients can see a reduction in the severity of their FMR with medical therapy alone [ ]. In select patients, cardiac resynchronization therapy is also needed to achieve reverse remodeling and reduction in mitral regurgitation [ ]. However, when these tools are insufficient to improve regurgitation, other invasive options should be considered [ ].