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SUMMARY After his first acute myocardial infarction, a 69-year-old male suffered the usually lethal complication of ventricular free-wall rupture. Early suspicion of possible rupture and immediate percutaneous insertion of an intraaortic balloon pump assist device afforded sufficient hemodynamic stability to proceed with cardiac catheterization. The diagnosis of ventricular free-wall rupture was confirmed and the extent of coronary artery disease defined. The patient underwent repair of the free-wall rupture and coronary artery bypass grafting and has returned to full activity.RUPTURE of the left ventricular free wall occurs in approximately 3% of patients hospitalized with acute myocardial infarction." 2 Approximately 10% of hospital deaths after acute myocardial infarction are secondary to rupture,'-making ventricular free-wall rupture the third most important cause of infarctionrelated death.4' Because hemodynamic decompensation usually occurs so' rapidly after myocardial freewall rupture, therapy has usually been unsuccessful in preventing death' in patients manifesting this complication. Only 10 patients have been reported who had successful surgical repair of myocardial free-wall rupture and survived to leave the hospital.6'2 We successfully treated a patient who had a rupture of the left ventricular free wall after myocardial infarction. Preoperative hemodynamic stabilization was achieved by intraaortic balloon counterpulsation,'3 which permitted catheterization so the rupture could be located before operation.