We experienced 2 rare cases of acute myocardial infarction (AMI) complicated by ventricular septal perforation (VSP) and right ventricular free wall rupture. Case 1 was a 70-year-old woman who developed VSP and cardiac rupture after percutaneous coronary artery thrombolytic therapy for AMI (total occlusion of left anterior descending branch (LAD) #6) and died of cardiac tamponade. Postmortem examination showed right ventricular free wall rupture. Case 2 was a 76-year-old woman. She developed

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... 6 days after percutaneous coronary artery intervention (stenting) for AMI (total occlusion of LAD #8). VSP was closed by the double patch repair technique. During operation, right ventricular free wall rupture (oozing type) was found, so hemostasis with fibrinogen was added. She was discharged in a satisfactory condition 4 weeks after surgery. Right ventricular rupture after AMI of the LAD region is rare. VSP may be associated with right ventricular free wall rupture complicated by AMI of LAD region because all of our cases were accompanied by VSP. Jpn. J. Cardiovasc. Surg. 34: 29-32 (2005) F, female; LAD, left anterior descending branch.