Myocardial infarction and biventricular free-wall rupture with shunting through a false aneurysm

A 65-year-old man presented with acute inferior myocardial infarction and received thrombolytic therapy with clinical evidence of coronary arterial recanalisation. Recovery was uncomplicated until- the eighth day when he experienced recurrent chest pain with evidence of reinfarction in the same territory. This was associated with the development of a pansystolic murmur and cardiogenic shock. Cardiac catheterisation showed right coronary arterial occlusion and inferior infarction with a false aneurysm and a left-to-right shunt (shunt ratio 2.5:1). Surgery confirmed the formation of a false aneurysm caused by rupture of the free walls of both ventricles. Importantly, however, the interventricular septum was intact and the left-to-right shunt was through the false aneurysm itself. This is the first report of biventricular free-wall rupture with shunting through a false aneurysm treated successfully by surgery.