INTRODUCTION Myocardial infarction (MI) remains the leading cause of death in the developed world. Over the last 20 years, advances in medical and surgical management of ischemic heart disease, including thrombolysis, percutaneous coronary intervention, and coronary artery bypass surgery, have resulted in a significant reduction in mortality and morbidity associated with acute MI. In addition, development and evolution of mechanical support devices has widened the surgical armamentarium. However, complications including ventricular septal and free wall rupture, acute mitral regurgitation, and arrhythmias still occur and remain a challenge for the treating physician and surgeon. The most serious of those complications is the development of cardiogenic shock that is associated with 80% mortality.