1. Symptoms related to heart failure that can be attributed to the mitral regurgitation and left ventricular ejection fraction > 30% (Class I)

2. Symptoms related to heart failure that can be attributed to the mitral regurgitation and left ventricular ejection fraction < 30%. Mitral repair not replacement likely. (Class IIa)

3. Asymptomatic severe mitral regurgitation if the left ventricular ejection fraction is < 60% and/or the end systolic dimension is > 40 mm. (Class I).

4. Asymptomatic severe mitral regurgitation with the left ventricular ejection fraction > 60% and end systolic dimension < 40 mm if atrial fibrillation or pulmonary hypertension is present (Class IIa).

5. Severe mitral valve regurgitation (usually from mitral valve prolapse) if repair rather than replacement is likely, even in the lack of symptoms and normal left ventricular ejection fraction (Class IIa).