The objective of this study was to investigate the usefulness of intraprocedural hemodynamic monitoring for MR evaluation during pMRV. Assessment of mitral regurgitation (MR) during percutaneous mitral valve repair (pMVR) procedure is challenging. 3D color Doppler allows exact quantification of MR, but is technically demanding. Sixty patients with moderate to severe MR (14 with structural and 46 functional MR) were included in the study. Intraprocedural pressure curves were continuously obtained in the left atrium (LA) and left ventricle (LV). Transesophageal echocardiography was performed using 3D color Doppler derived mean vena contracta area (VCA_mean) and mitral regurgitation volume (RegVol) to quantify MR severity before and after each clip implantation. In the entire patient group, strongest correlations were observed firstly between VCA and the raise of the ascending limb of the left atrial V pressure wave (V_ascend; r = 0.58, p < 0.001) and secondly between the difference of peak V wave pressure and mean LA pressure divided by systolic LV pressure [(V_peak − LA_mean) − LV_systole; r = 0.53, p < 0.001]. In patients with structural MR, the highest area under the ROC curve for prediction of mild MR (VCA_mean < 0.2 cm² and RegVol < 30 ml) after clip implantation was found for V_ascend (AUC 0.89, p < 0.001) whereas in functional MR calculation of (V_peak − LA_mean) − LV_systole showed the highest predictive value (AUC 0.69, p = 0.003). Invasive pressure monitoring can give a direct feedback with regard to the success of clip placement during pMVR.