Penetrating injuries to the heart are usually devastating and few patients survive the initial trauma. The most frequent penetrating injuries are caused by projectile injuries and less commonly by melee weapons. Most of these injuries involve chamber free walls and a small percentage can affect the interventricular septum. We report a case in which an emergency surgical procedure was successful in controlling cardiac tamponade, and repairing a right ventricular laceration caused by multiple stab wounds. Subsequently, a successful interventional occlusion of a large interventricular septal defect, associated with significantly augmented pulmonary flow was performed.