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A 68-year-old woman was investigated for presyncope. She had undergone a subaortic Dacron patch plasty for a ventricular septal defect (VSD) 24 years previously. The patient had no other complaints. The physical examination was unremarkable. A resting ECG showed sinus rhythm with complete left bundle branch block. Transthoracic echocardiography demonstrated a bizarre banana-shaped outpouching 45 mm in length arising from the interventricular septum and spreading towards the right ventricular apex (figure 1). The saccular lesion filled approximately 40% of the right ventricle. Myocardial thickness of the outpouching and of the remaining left ventricle was 8 mm and 12–13 mm, respectively. A synchronous contraction with the ventricular mass, preserved myocardium and a narrower ‘collet’ of 20 mm compared with the maximal …
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