Left ventricular wall perforation after acute myocardial infarction, without immediate rupture to fatal haemopericardium, is a rare complication that may result in a pseudoaneurysm. Transoesophageal echocardiography demonstrated a posterior wall perforation and the unique blood flow pattern at the neck of a pseudoaneurysm 6 days after acute myocardial infarction. In a second patient with angina and congestive heart failure 7 years after an acute myocardial infarction echocardiography demonstrated a huge pseudoaneurysm. Surgical repair was successful in both patients. Turbulence of blood at the neck of a pseudoaneurysm generates a murmur, and systolic regurgitation into a large aneurysm may cause symptoms of heart failure. Exact diagnosis, anatomical relations and size can be assessed with echocardiography. Angiography is required before surgery only to rule out coronary artery pathology. Occasionally a pseudoaneurysm may persist for many years but because of a high risk of rupture, prophylactic repair is indicated soon after diagnosis.