Acute mitral regurgitation and ventricular septal defect after myocardial infarction are devastating complications with high mortality. Surgical intervention is warranted for these entities, but the timing of operation remains controversial. In a previous retrospective study of patients with acute mitral regurgitation, we concluded that early emergency operation be undertaken. We describe nine patients subsequently seen at the Mayo Clinic (seven with acute mitral regurgitation and two with acute ventricular septal defect) who underwent emergency operation within four days of evaluation. Four patients were operated on within four hours after the onset of their complications. All patients survived the perioperative period. Eight of nine are alive and well over a mean follow-up period of 9.7 months. We recommend early surgical repair of mechanical complications after acute myocardial infarction.