A 53-year-old Caucasian male presented to the emergency department with epigastric pain for three days. The electrocardiogram (ECG) showed 2 mm coved ST segment elevation in the inferior leads and Q waves in leads III and aVF suggestive of acute inferior myocardial wall infarction. He underwent emergent coronary angiography which revealed a diffusely diseased left coronary system and a total occlusion of the proximal right coronary artery. Coronary blood flow was successfully restored with balloon angioplasty followed by placement of a bare metal stent. However, the right coronary artery remained partially occluded after the bifurcation due to distal embolization. Transthoracic echocardiography (TTE) showed akinesis of the basal inferior myocardial segment. On hospital day six, the patient developed the sudden onset of respiratory distress and hemodynamic instability with a new loud pansystolic murmur heard over the entire precordium. Repeat TTE showed a high velocity left-to-right turbulent jet across the inferobasal septum indicative of a VSR. Dilatation of the right ventricle was also noted. The patient became tachypneic, tachycardic and hypotensive, and required placement of an intra-aortic balloon pump for hemodynamic support. A transesophageal echocardiogram (TEE) confirmed the presence of a large defect in the inferobasal septum measuring approximately 1.6 cm causing a significant left-to-right shunt consistent with VSR. The patient underwent emergent repair of the VSR with a bovine pericardial patch. His postoperative course was uncomplicated.