A 67 year-old-man suffered an uncomplicated myocardial infarction twenty years ago. By January 1990 an abnormal cardiac contour was noted on a chest radiography. Contrast ventriculography revealed a pseudoaneurysm of the left ventricle. The patient underwent open heart surgery and remains asymptomatic 12 months after surgery. This is the longest time interval between the myocardial infarction and successful surgery that has been reported.