Post-myocardial infarction (MI)ventricular septal defect (VSD) is a mechanical complication that has become infrequent since the advent of reperfusion strategies however, it is associated with cardiogenic shock in 12% of cases and represents a significant mortality factor. Surgical treatment is often mandatory in the early period after anterior myocardial infarction(AMI) .Thus, early and appropriate management can reduce 30-40% mortality at 30 days.(1) We present three cases of anterior myocardial infarction complicated by apical VSD, emphasizing the major role of echocardiography in the diagnosis of this fatal complication.