Anterior mitral valve leaflet (AMVL) perforation is most commonly seen in the setting of infective endocarditis. We present a case of AMVL perforation in a previously healthy 62-year-old male who presented with a six-month history of worsening dyspnea and peripheral edema. Blood cultures, inflammatory markers, and autoimmune profile were negative. Transthoracic echocardiography demonstrated severe mitral regurgitation (MR) with a possible AMVL perforation, which was confirmed by three-dimensional transesophageal echocardiography as a well-circumscribed hole in the A2 segment. The patient made a successful recovery from mitral valve repair surgery.