This tape illustrates surgical repair of a posterior post-infarction ventricular septal rupture secondary to inferoposterior myocardial infarction. The essentials of the repair include a transinfarct left ventricular incision posteriorly, complete left ventricular infarctectomy, patch repair of the ventricular septal defect and prosthetic patch replacement of the left ventricular wall defect created by infarctectomy. This video presents an improved technique over the earlier version in that the left ventricular free-wall patch is applied epicardially in order to avoid bleeding at the margins of the patch where the muscle may be friable. This improved method has markedly reduced the incidence of bleeding problems associated with this operation.