Objectives: Impact assessment of mitral valve replacement associated with surgical treatment of post-infarction ventricular septal defect in terms of morbidity and mortality in a single center experience. Methods: There were analyzed 34 patients with postinfarction ventricular septal defect (VSD) treated surgically between January 2007 and June 2013 (15 men, 19 women, mean age 62.07 years). VSD sites were localized to the apical septum (16 cases), central (7 cases) and posterior (11 cases). Significant mitral regurgitation was detected in 9 cases (26.4%), 7 of them in combination with posterior VSD (63.6%) and the other two with previous VSD (12.5%). Aortocoronary bypass was necessary in 19 cases, two of them in association with mitral regurgitation. In all cases mitral regurgitation valve replacement was performed. Results: 26 (83.8%) of the patients presented with cardiogenic shock, and all of the patients with acute mitral regurgitation presented with acute cardiogenic shock at admission. In all cases IABP was implemented before surgery. Overall mortality was 38.2% (13 cases). Mitral valve replacement was associated with increased clamping time, increased risk for developing MODS, prolonged hospitalization in ICU and a significant increase in mortality at 30 days (6 cases – 66.6% mortality). Conclusions: Th e combination of mitral regurgitation in post-myocardial infarction ventricular septal defect is an important risk factor for increasing morbidity and mortality rates.