A 66-year-old man was referred in cardiogenic shock due to acute myocardial infarction. Echocardiography revealed severe mitral regurgitation with prolapse of the posterior mitral leaflet due to papillary muscle rupture. Emergency coronary angiography showed subtotal occlusion of the left circumflex coronary artery. A percutaneous coronary intervention was performed immediately. After inducing percutaneous cardiopulmonary support, emergency mitral valve replacement was carried out. The anterior and posterior papillary muscles attached to the posterior mitral leaflet were completely ruptured. Pathological findings showed massive necrosis.
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