Septal dissection and rupture evolved as an inferobasel pseudoaneurysm

We report two cases of postinfarction dissecting hematoma of the interventr icular septum with restrictive ventricular septal defect that evolved as an inferobasal pseudoaneurysm. The difficult anatomical pattern was assessed by two-dimensional (2-D) echocardiography with Doppler and color analysis, left ventriculography and perioperative transoesophageal echo. Because the patient had no signs of heart failure, the surgical repair was successfully delayed until the dissecting tissue became fibrotic. Problems of diagnosis , decision making and surgical management are discussed. (C) 2001 by The So ciety of Thoracic Surgeons.