Acute post-infarction posterior ventricular septal defect (VSD) is associated with high mortality. Furthermore, patients with cardiogenic shock have been reported to have worse outcomes (1). There are conflicting reports about the optimum timing and method of surgical repair (2). Early surgical intervention has been reported to have high mortality, whereas the risk of dying in the waiting period with the medical management is also exponentially high (1). We present a case of post-infarction posterior VSD complicated by cardiogenic shock. The patient was successfully supported with peripheral veno-arterial extracorporeal membrane oxygenator as a bridge to a trans-right atrial repair.