Case 1 : A 63-year-old male with known CAD and prior CABG presented with chest pain and inferior ST elevation MI. Angiogram showed no culprit lesion, and a left to right shunt suspicious for an ischemic VSD. Transesophageal echocardiography confirmed an inferior VSD. Cardiac CT was done as procedural planning for percutaneous closure, and this showed a complex LV free wall defect with intra-myocardial dissection extending into the right ventricle, rather than a VSD ( Fig. 1 ). Patient underwent an urgent successful surgical repair.