Abstract
A 53-year-old male individual with chronic severe mitral regurgitation presented with biventricular dysfunction, pulmonary hypertension, and atrial fibrillation. Echocardiography demonstrated a posterior leaflet prolapse with malcoaptation. Mitral valve repair and Maze procedure were performed, revealing absent chordae and direct connection from the anterolateral papillary muscle to the posterior leaflet, consistent with partial mitral arcade. Post bypass, left ventricular dysfunction was addressed by intraaortic balloon pump placement and delayed sternal closure. Post chest closure echocardiography showed no residual mitral regurgitation and restored biventricular function. This case highlights a rare presentation of mitral regurgitation with unique anatomical anomaly, successfully managed with a comprehensive surgical approach.