We present the case of a 47-year-old man who presented with asymptomatic ischemic cardiomyopathy. His left ventricular end-diastolic volume (EDV) measured 302 ml, ejection fraction (EF) was 30%, and a large akinetic area with no typical aneurysm was present. He was managed medically but within three years his ventricle remodeled, developed an aneurysm and ruptured. He was operated on using our own modification of the Dor/Menicanti method and autoseptoplasty with no patch. The operation decreased EDV from 950 ml to 205 ml and improved EF from 5% to 55%. In addition, the ventricle became conical with no akinetic segments. This case shows that in some patients surgical ventricular reconstruction may be unavoidable. Good quality of proximal segments ensures a favorable outcome of surgery even in extremely enlarged ventricles with very low EF. The surgical technique presented may be used in cases of grossly enlarged ventricles.