We report a rare case of a 31-year-old man with chronic severe mitral regurgitation as a result of perivalvular ventriculoatrial fistulous communication with a history of remote blunt chest trauma at age 19 to 20 years who underwent successful surgical repair. Mitral regurgitation after blunt trauma is usually secondary to rupture of the chordae tendinae or papillary muscles and perivalvular regurgitation is a very rare event especially after remote blunt chest trauma. We present a case with severe mitral regurgitation secondary to remote blunt chest trauma as a result of perivalvular ventriculoatrial fistulous communication.