Most penetrating right ventricular injuries require simple suture repair, but more extensive injury or rupture of the right ventricle may not be amenable to this method. We have developed an approach to the problem and a technique for repair. Compression of the area with early institution of cardiopulmonary bypass will result in decompression of the right ventricle and preservation of perfusion, preventing profound hypotension. Coverage with an onlay autologous tissue patch provides hemostatic control of the defect without compromising ventricular function. Reinforcement with omentum or muscle flap can give additional protection when risk of infection is present. Application of these principles can be lifesaving and insure good cardiac function despite massive injury to the right ventricular myocardium.