21 patients were operated on the reason of postinfarctial ruptures of interventricular septum within 1989-2009 years. The mean age was 61.3 ± 7.8 years. The preoperative diagnostic means were echocardiography and magnetic resonance imaging. All patients were in critical condition, demonstrated postinfarctial left ventriculum remodeling and significant decrease of its functional reserves. Myocardial revascularization together with septal reconstruction, mitral valve and ventricular cavity reconstruction were performed. The analysis of the results proves that the active-expectant treatment tactics leads to the significant decrease of perioperative lethality. The optimal volume of surgical treatment is a liquidation of the interventricular defect together with geomentrical reconstruction of the ventricular cavity, wich is indepentant from the stage of infarction.