Background: Acute cardiac rupture is a life-threatening complication of acute myocardial infarction. Traditional methods of surgical treatment by infarctectomy with mattress suture repair are associated with a high mortality. Recently, new approaches involving an onlay patch without infarctectomy have been introduced with promising results. Our previous experimental work showing that the recently infarcted myocardium recovers poorly after aortic cross-clamping and cardioplegic arrest suggested that repair of rupture using ventricular fibrillation is preferable. Methods and Results: We report 4 consecutive patients who have been successfully treated using a technique involving an onlay patch of pericardium secured with glue and a circumferential suture. In 2 cases it was possible to complete the repair without cross-damping the aorta. Conclusion: Ventricular rupture can be successfully repaired using an onlay patch and repair can be accomplished without the use of cross-clamping or cardioplegia.