Mechanical complications after acute myocardial infarction have a very high mortality rate on their own (40-50%), and the sum of these increases the risk of mortality after surgical repair. In this case report, we present a patient with a postinfarction ventricular septal defect of posterior location and early presentation with hemodynamic stability. Subsequently, the patient presented with severe acute mitral regurgitation plus posterior ventricular aneurysm. A surgical procedure with successful resolution is performed. Early diagnosis, patient selection, and adequate multidisciplinary management optimize successful outcomes. This communication aims to expose a clinical case with these characteristics since, in the literature, there are very few cases of living patients with these three complications who survived the acute event and even more after surgical repair.