A 65 years male presented with a history of breathlessness. He gave the history of two events of documented inferior wall myocardial infarction and was in New YorkHeart Association Class IV.

There was a grade4/6 systolic murmur in the mitral area radiating to the back and axilla. Transthoracic echocardiography revealed a large sub-mitral aneurysm with severe mitral regurgitation.