Although in patients with interventricular septum rupture complicating acute myocardial infarction urgent cardiac surgery is suggested as a method of choice by current ESC and ACC/AHA guidelines, mortality is high. In some patients, intra-aortic counterpulsation and optimisation of medical therapy may stabilise patients condition and increased the safety of elective cardiac surgery which can be performed a few weeks later. In this report we describe two patients with this condition who were successfully treated using a conservative approach and subsequent elective surgery.