We report a case with left ventricular pseudo-aneurysm and ventricular septal perforation after acute myocardial infarction. A 77-year-old man was admitted because of repeated chest distress and chest pain for 1 week, which was diagnosed by an electrocardiogram with acute anteroseptal ST-segment elevation myocardial infarction and troponin T elevation. The transthoracic echocardiography and cardiac magnetic resonance showed the left ventricular apical pseudo-aneurysm and lower segment of ventricular septal perforation, and confirmed by left ventriculography. Surgical treatment was performed, with operation procedure successfully. In this article, we report a rare case in clinical and review the literatures of left ventricular pseudo-aneurysm.