The technique of surgical repair of an acute ventricular septal defect by distal extension of the septum with a patch is shown.This method allows preservation of the size of the right and left ventricular cavities and is useful when infarction involves both ventricles. Preoperative coronary arteriograms and left ventriculograms, as well as postoperative contrast echocardiograms are shown. The patient is a 79 year old female who was transferred to our hospital in severe congestive heart failure 10 days after an antero-septal myocardial infarction.