A 68-year-old male with post myocardial infarction left ventricular aneurysm (LVA) complicated by ventricular septal perforation (VSP) was treated surgically. At first, he was admitted with acute myocardial infarction by a physician. Coronary angiography (CAG) revealed a total occlusion of the left anterior descending coronary artery. It was improved to 99% of stenosis by PTCR. Echo cardiography revealed the VSP. However, the patient was approached conservatively because of complications of severe pneuminitis and acute hepatitis. Cardiac catheterization was performed three months after admission. The data on the catheterization are as follows: Left ventricular (LV) wall dyskinesis is presented at segment 1-5. Global ejection fraction (EF) = 26%, Corrected EF = 40%, LVEDP = 36 mmHg, Qp/Qs = 1.8. Elective surgery was then performed with IABP, LVA was resected 90 x 50 mm in size under ventricular fibrillation. VSP, which was 9 mm in size, was closed directly with Teflon felt strips. LV plication was then made with 3.0 polypropylene under cardiac arrest. Reconstruction of the LV was then performed with a double patch, of which a cow pericardium was laid on top of a Gore-Tex patch. Post operative cardiac function was improved remarkably. We consider this procedure excellent because of the avoidance of thrombus and the maintenance of the LV form.