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A 56-year old man developed a cardiogenic shock 24 hours after a postero-inferior myocardial infarction. The coronary angiogram revealed a dominant right coronary artery occluded at the origin of its third segment. Transoesophageal echocardiography showed a complex basal ventricular septal rupture at the level of the membranous septum (panels A and B). The rupture was accompanied by an extensive haemorrhage into the muscular ventricular septum and into the interatrial septum, creating a left atrial dissection (panel C).
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