Ischaemic mitral regurgitation is a relatively common manifestation of coronary artery disease and occurs after acute myocardial infarction or as a chronic condition, and less commonly as regional episodic ischemia. It is defined as mitral regurgitation occurring more than one week after myocardial infarction (MI) with (1) one or more left ventricular segmental wall motion abnormalities; (2) significant coronary disease in the territory supplying the wall motion abnormality; and (3) structurally normal MV leaflets and chordae tendinae. Studies have shown that ischaemic mitral regurgitation was associated with an increased one year mortality which correlated with the severity of regurgitation. Patients with IMR may be asymptomatic, present with ischaemic symptoms of angina, or with heart failure symptoms according to the degree of mitral regurgitation and LV dysfunction. The primary purpose of diagnostic studies is to determine the severity of coronary arterial disease and its anatomy, the severity of MR, the degree of LV dysfunction, and the potential for LV function to improve after revascularization.The proper management for concomitant mitral regurgitation (MR) at the time of coronary artery bypass grafting (CABG) in the absence of structural mitral valve disease remains controversial. For the two extremes of severity, there is little controversy. For 1+ MR or less, CABG suffices. For 4+ MR, the valve disease needs to be addressed specifically. However, for the range of 2+ to 3+, proper management is yet to be determined. The surgical treatment options for ischaemic mitral regurgitation are either repair or replacement of the valve, with repair imparting better survival.