Left ventricular rupture following mitral valve replacement (MVR) with preservation of the posterior leaflet is presented. A 63-year-old man underwent combined AVR, MVR with preservation of the posterior leaflet and TAP under cardiopulmonary bypass with moderate hypothermiat to 28 degrees C and tepid blood cardioplegia. Although a 31-mm valve would fit to the mitral position, a 27 TEKNA was chosen for MVR. Beyond the cardiopulmonary bypass, a left ventricular rupture was found. Cardiopulmonary bypass was re-stated and the aortic clamp was replaced. After removal of the mitral valve prosthesis, an internal tear was detected below the anterolateral commissural area (Type I). The tear was repaired with two 3-0 monofilament buttressed sutures incorporated with felt strips and covered with a bovine pericardial patch by several interrupted pledgeted mattress sutures. Gelatin-resorcin-formaldehyde/Glutaraldehyde glue (GRF) was used to reinforce the ruptured myocardium and to fix a bovine pericardial patch to the affected ventricular wall. Then the prosthesis was re-seated. Although the aortic clamp time was 319 mins., the patient was weaned from the cardiopulmonary bypass easily with the prophylactic use of IABP. The patient was discharged and returned to his previous job.