Percutaneous interventional procedures for mitral valve started with treatment of mitral stenosis (MS) of rheumatic etiology wherein balloon inflation was done to open up the stenotic valve. This procedure is considered as a first-line management in patients with significant MS of rheumatic heart disease origin when the valve morphology is suitable and has been the mainstay in interventional management of these patients for many decades. However, over the last decade, there has been a lot of interest in percutaneous management of the patients with significant mitral regurgitation (MR) of non-rheumatic origin who cannot undergo surgery because of a high risk of perioperative morbidity and/or mortality. This has led to emergence of new techniques wherein significant MR in this subset of patients can now be reduced by way of percutaneous methods. This chapter highlights how crucial the role of echocardiography is in the detection of mitral regurgitation and stenosis and its associated structural abnormalities and how best it can support transcatheter interventions for the management of these patients.