The case described by Ikegami and McCarthy [1] exemplifies one of the rarest complications after mitral prosthetic implantation. It is difficult to know which of the conditions described here, such as perforation of the aortic valve, mitral periprosthetic leak, left ventricular (LV) pseudoaneurysm, or the amount of all of them was the cause of the patient's symptoms. Left ventricular rupture after mitral valve replacement is a rare but dreaded and potentially lethal complication of mitral valve surgery, with an incidence up to 1%. Predisposing factors include non-sparing subvalvular structures of the posterior leaflet, extensive annular decalcification, insertion of an oversized prosthesis, redo mitral valve replacement, a stented bioprosthesis implanted in a small LV cavity, and infective endocarditis. Sometimes, this rupture is incomplete and may be noticed only as a small hematoma on the posterolateral wall of the LV. Theoretically, LV pseudoaneurysm can develop at the site of a previous rupture, contained by the surrounding pericardium or extracardiac tissue [2]. Nowadays, the wide use of echocardiography allows detection of acute pseudoaneurysms. Chronic pseudoaneurysms are generally detected during investigation of cardiac failure, and up to 10% to 20% incidentally [3]. The presence of a neck smaller than the aneurysmal cavity is strongly suggestive of a pseudoaneurysm, especially if colour Doppler shows a turbulent flow at the neck [4]. The decision to operate is given taking into account the presence of congestive heart failure, and the size of the pseudoaneurysm (>3 cm in diameter). Otherwise, surveillance with echocardiographic control is indicated [5]. Pretre et al. emphasize this attempt of guidelines for the management of LV pseudoaneurysms [5]. Finally, the video is very nice. Conflict of interest: none declared.