In this issue four cases are described1-4 in which the authors illustrate their experience with the very uncommon surgical challenge of false (or pseudo) aneurysm of the left ventricle. Although this condition is seen infrequently, it should be recognised and distinguished from the common type of left ventricular aneurysm. It is said to have a propensity for rupture, and may cause symptoms of heart failure. It is eminently operable if it is approached with an understanding of its anatomy and certain characteristic features.

The basis of the condition is a contained rupture of the free wall of the myocardium.5-8 Acute rupture of the myocardium is in fact quite common. Of patients dying of infarction, 17% have been found to have ruptured the heart through the infarcted area.9 Free wall rupture is four to five times more common than septal rupture,9 presumably a simple reflection of the relative volumes of myocardium at risk, but it is usually immediately fatal. These are among the cases described as “EDM” (electromechanical dissociation) when they collapse some days after infarction, with a peak incidence at 3–5 days.7 The ventricle is beating but no output is generated because of tamponade. The patients with ruptured myocardium who survive to operation in the period soon after …