Ventricular septal rupture (VSR) is a devastating complication following myocardial infarction. It occurs in 0.17-0.31% of cases post-primary PCI, usually 2-8 days post-MI. Risk factors include older age, female sex, late presentation, extensive MI, hypertension, and lytic therapy. Diagnosis involves acute deterioration, auscultation findings, echocardiogram, and CT scan. Management uses a hybrid approach of primary PCI of the culprit vessel followed by transient mechanical support like IABP, then definitive surgical or percutaneous repair. Without treatment, mortality is over 90% at 1 year. Challenges include friable tissue that cannot hold sutures early on and