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To appreciate the mechanistic role of current percutaneous therapies, it is important to understand the anatomic and functional properties of the mitral valve apparatus. The mitral valve is complex anatomic structure. Its proper function strictly depends on the structural and functional integrity of its individual components, which include the mitral valve annulus, leaflets, chordae tendineae, and subvalvular apparatus, including the papillary muscles and left ventricular wall (Fig. 1). Derangement of one or more these components characteristically typically results in flow-limiting (ie, stenosis) or regurgitant valvular dysfunction. In either case, a thorough appreciation of the disease mechanisms is essential for the conceptualization and development of alternative, less-invasive, percutaneous mitral valve therapies.