We experienced a case of 62-year-old man with ischemic cardiomyopathy and mitral regurgitation. He had a heart failure of New York Heart Association class IV together with unstable angina. His further examination showed an enlarged left ventricle with markedly reduced ejection fraction (12.9%) and ischemic mitral regurgitation of grade III associated with 3-vessel disease. He underwent three coronary artery bypass graftings and mitral annuloplasty by a modification of Kay's method. He showed a remarkable improvement of heart failure and cardiac function together with a disappearance of mitral regurgitation. He discharged from hospital in NYHA class II on the 50th postoperative day and lives an almost normal life now. Operative indication and management of ischemic cardiomyopathy and mitral regurgitation were discussed.