Complications of myocardial infarction such as left ventricular aneurysm, chronic ischemic mitral regurgitation and heart failure are as sociated with a poor prognosis. The management of complex defects is challenging and requires an individualized strategy. We describe a case of a 44-year-old male with multiple complications of myocardial infarction including heart failure with reduced ejection fraction, left ventricular aneurysm and mitral regurgitation, treated with mitral valve replacement and left ventricular reconstruction. We discuss pathophysiology and treatment of chronic ischemic mitral regurgitation and left ventricular aneurysm