We present a case of acute (blowout) left ventricular free wall rupture (LVFWR) that occurred on the third day after inferior myocardial infarction. Because electromechanical dissociation developed abruptly and pericardiocentesis was no effective, there was no time for establishing a cardiopulmonary bypass (CPB). Emergency thoracotomy and direct closure were successfully performed at the bed-side. We believe that acute type of LVFWR in which initial symptom is electromechanical dissociation without any preceding symptoms can be rescued by emergency thoracotomy and direct closure of the rupture with no aid of CPB provided that the rupture is a small tear located on the anterior, lateral, or even the inferior wall of the left ventricle, if hemodynamical stability is obtained.