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Current three-dimensional echocardiographic technology, including live three-dimensional transesophageal echocardiography and single-beat three-dimensional color Doppler imaging, are providing valuable new insight into the mechanism and quantification of mitral valve regurgitation.We discuss recent applications of three-dimensional volumetric leaflet imaging with emphasis on the distinction between organic and functional mitral regurgitation. We also discuss the added benefit of current and emerging three-dimensional color Doppler methods for the quantification of mitral valve regurgitation severity. The limitations of the two-dimensional proximal isovelocity surface area method are discussed, along with potential solutions provided by three-dimensional color Doppler imaging methods. Methods to directly measure the regurgitant jet vena contracta area are presented, along with recent clinical studies comparing this method with two-dimensional Doppler and cardiac MRI reference standards.The use of three-dimensional color Doppler methods has now been well validated for the accurate and reproducible quantification of mitral valve regurgitation severity. These newer tools are now clinically available and should be incorporated into the routine Doppler assessment of mitral valve regurgitation severity.