Ventricular wall rupture after mitral valve replacement is an uncommon complication but often lethal. We report the autopsy findings in a case of a 77 year old woman suffering double mitral disease who underwent unsuccessful replacement of the mitral valve using a Saint Jude (ONXM 27/29) mechanical prosthesis. The patient developed consumptive coagulopathy and a type I left ventricular rupture. Her family filed a claim before a court pressing charges against the surgeon. A legal autopsy was ordered and performed. After our forensic report the family dropped the charges.