Inclusion Criteria:  Adult Ischemic NoIschemic cardiomyopathy EROA> 0,2 cm2 or Regurgitant Volume > 30 ml (ESC guidelines). EROA ≥ 0.4 cm2 with tethering (ACC/AHA) MR Grade 3/4 Eligible for TEE, surgical repair and replacement of mitral valve Coronary artery disease with or without the need for coronary revascularization Average value LVEDD 62 mm LVEF 42%  Exclusion Criteria:  Pediatric Any echocardiographic evidence of structural (chordal or leaflet) mitral-valve disease ruptured papillary