Papillary muscle rupture (PMR) is a rare, but catastrophic mechanical complication of acute myocardial infarction (AMI). Patients with PMR present in acute pulmonary edema and commonly in cardiogenic shock. The absence of new heart murmur after AMI dose not exclude the diagnosis. To diagnose PMR accurately, transesophageal echocardiography is the most useful and essential, coronary angiography is also necessary for appropriate surgical treatment. Based on these results of diagnostic procedure, combined myocardial revascularization and mitral operation should be performed without delay. Although mitral valve repair has the effects of improving left ventricular function, repairing could be undertaken successfully in limited cases, such as ruptured muscle tissue is not friable. If repair is technically more challenging, mitral valve replacement should not be hesitated. Postoperative early and late survival may relate to surgical correction of coronary artery revascularization, especially in multivessel disease, concomitant coronary artery bypass grafting is benefit theoretically and should be performed.