A 34-year-old male underwent double valve replacement with mechanical mitral and aortic prosthesis for rheumatic heart disease-severe mitral stenosis and moderate aortic stenosis and was asymptomatic at 1-year follow-up. On echocardiogram, a large aneurysmal sac arising from the left ventricle (LV) originating infero-posteriorly, passing anteriorly and compressing the right atrium and right ventricle was delineated (Figure 1A, B; Movie 1, 2). There was to-and-fro color flow into the cavity through a narrow neck (~20 mm) suggesting a large pseudoaneurysm (PSA) (Figure 1C, D; Movie 3). Normally functioning mitral (mean gradient 3.0 mmHg) and aortic (mean gradient 10 mmHg) prosthesis were noted. CT angiogram confirmed a giant lobulated PSA (13 × 12 × 10 cm) from the postero-inferior LV, coursing across AV groove and extending inferolaterally compressing the right hemi-diaphragm and superior surface of liver (Figure 2A, B, C). Though the superior part of sac had myocardial covering, the lower extension was covered with pericardium only. Two additional small PSAs were noted, one from superolateral LV wall (Figure 2D, E) and another from juxtavalvular aortic area (Figure 2B, F). The patient was advised urgent aneurysmectomy which he refused and was lost to follow-up.