A 52-year-old patient with coronary artery disease complicated by massive myocardial infarction, septal perforation, left ventricular wall tumor, and heart failure underwent coronary artery bypass grafting with septal perforation repair, left ventricular wall tumor closure, and left ventricular decompression angioplasty, and was discharged from the hospital on September 12 after a smooth recovery with good cardiac function. The patient was rushed to the local hospital for sudden onset of syncope and dyspnea due to coronary artery disease and was diagnosed with acute extensive anterior and inferior wall myocardial infarction and heart failure. The patient’s heart function was extremely poor, and he was unable to lie down due to panic and shortness of breath with slight activity. Coronary angiography showed complete occlusion of the coronary artery trunk, and echocardiography showed ventricular septal perforation and left ventricular wall aneurysm formation, secondary to severe pulmonary hypertension, and the patient was at risk of sudden death. The patient was transferred to the Cardiac Surgery Department of Qilu Hospital on September 2 for further treatment. After active preparation, surgery was performed on September 4. The septal perforation was 2 cm in diameter, and one third of the left ventricle was dilated and expanded due to myocardial infarction, forming a ventricular wall tumor with the thinnest part of only 3 mm. A 2.5-cm-long thrombus was removed from the coronary artery trunk, and a coronary artery bypass graft was performed because the proximal end of the thrombus was still occluded. Adequate preparation, intensive intraoperative myocardial protection, and skilled surgical technique ensured the success of the complex procedure. The postoperative echocardiogram showed that the ventricular septal perforation disappeared, the left ventricle recovered its normal size and shape, and the cardiopulmonary function improved significantly. The patient recovered smoothly after the operation and got out of bed freely without any discomfort. The patient was discharged after 10 days of hospitalization. The success of this operation marks our hospital’s advanced level in the surgical treatment of critical coronary artery disease in China. Coronary myocardial infarction complicated by septal perforation is the most serious complication after myocardial infarction. It is reported in literature that about 2% of acute myocardial infarction is complicated by septal perforation, and without timely surgical treatment, half of the patients will die within a week, and only about 15% of the patients can survive for a month, so surgical treatment is the most effective means to save patients’ lives and improve their prognosis. However, these patients are often combined with ventricular wall tumors due to their critical condition, which makes surgery technically difficult and the success rate of previous surgery is low. In recent years, due to the improvement of surgical techniques, the update of materials, the enhancement of myocardial protection, and the support of preoperative cardiac assist devices, the success rate of surgery in Europe and America is higher. However, there are few patients who can be saved by surgery in China, and the success of this type of surgery is the first case in Qilu Hospital and very rare in the province. In recent 20 years, there were only 47 cases of myocardial infarction complicated by ventricular septal perforation in China, and the success rate of surgery has increased significantly in recent years, and the surviving patients have good quality of survival. Because of the rapid progression of myocardial infarction complicated by ventricular septal perforation and high natural mortality, early medical consultation, early diagnosis and early treatment are important measures to save patients’ lives. It is important to master the timing of surgery, and active and appropriate management of combined ventricular wall tumors and coronary artery lesions, enhanced myocardial protection and application of cardiac assist devices can significantly improve the postoperative survival rate. In addition, thrombolytic therapy after myocardial infarction is a risk factor for ventricular septal perforation, and thrombolysis should be stopped as soon as ventricular septal perforation is suspected.