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A Marfan patient presented with a bilobar apical pseudoaneurysm after repeated surgery. These abnormalities were demonstrated by three-dimensional-echo, Doppler, and CT-reconstruction. The pseudoaneurysm was related to an apical venting procedure. In this case, a conservative approach was chosen, although in general, pseudoaneurysms form an indication for operative correction, because of the risk of rupture and acute tamponade.

A 70-year-old woman presented to the cardiac emergency department with recurrent nearcollapse. Two weeks before admission she had undergone mitral valve surgery for severe regurgitation.Physical examination revealed no significant abnormalities. The electrocardiogram showed sinus rhythm with low voltage P waves and incomplete right bundle branch block, and a severely prolonged QT interval of 660 ms at a heart rate of 56 beats/min, with negative T waves in the anterolateral leads (figure 1). Her medication on presentation consisted of digoxin 0.125 mg once daily and sotalol 80 mg three times a day. The serum potassium level was 4.18 mmol/l, magnesium 1.02 mmol/l and creatinine 76 µmol/l. A second ECG showed an R-on-T phenomenon where the premature R wave seemingly fuses with the ongoing T wave (figure 2). This seemingly fused complex shows massive ST depression and ST elevation as a sign of a large electrical gradient between the immediately repolarised or repolarising region in the Figure 1. ECG showing a clearly prolonged QT of 660 ms (scale 10 mm/mV and 25 mm/s).