A 65-year-old woman presented at a hospital with an inferior-wall acute myocardial infarction (AMI). She was in cardiogenic shock with hypoxic respiratory failure. Emergency left-sided heart catheterization revealed an occluded right coronary artery. An intra-aortic balloon pump was placed, and she was transferred to our hospital.

Transesophageal echocardiograms (TEE) showed a completely ruptured head of the posteromedial papillary muscle (Fig. 1A), with severe secondary eccentric mitral regurgitation visible in color-flow (Fig. 1B) and continuous-wave Doppler (Fig. 1C) modes. The patient underwent emergency surgical mitral valve replacement with use of a 25-mm Carpentier-Edwards bioprosthesis (Edwards