A 70-year-old patient presented with ventricular tachycardia and left ventricular failure. He was found to have a communication between a posterior left ventricular aneurysm and the right atrium. The causal myocardial infarction had been silent. This defect was satisfactorily closed at operation from which he made an uneventful recovery. This is the first report of a left ventricular-right atrial communication developing in association with ischaemic heart disease and highlights the role of transoesophageal echocardiography in the diagnosis and surgical management of such a condition.