Giant left ventricular pseudoaneurysm after ventricular assist device explantation in Marfan syndrome

We report the case of a 36-year-old woman with Marfan syndrome and a history of multiple complex cardiovascular procedures. She initially underwent valve-sparing aortic root and partial arch replacement for severe regurgitation and aneurysm. One year later, she developed acute DeBakey IIIb dissection, managed conservatively. Her course was complicated by recurrent regurgitation, progressive heart failure, and electrical storm. She subsequently underwent aortic valve and total arch replacement with frozen elephant trunk and extra-anatomical bypass of the left subclavian artery (L. SCA bypass), followed by central extracorporeal membrane oxygenation. Persistent low-output syndrome necessitated conversion to a Nipro-Toyobo paracorporeal biventricular ventricular assist device (VAD), later withdrawn after recovery. The left ventricular (LV) inflow cuff was closed with sutures, without infection. Postoperatively, retrograde endoleak from the bypass required additional endografting and subclavian coiling. Three years later, she presented with chest tightness. Computed tomography revealed a giant LV pseudoaneurysm (7.4 × 8.5 cm; Panel A–C, white arrow). Intraoperatively, the VAD inflow cuff had detached from the LV apex, leaving a 3 × 2 cm defect (Panel D, asterisk). Closure was achieved using a double-layer bovine pericardial patch via left anterolateral thoracotomy (Panel E, Supplementary data online, Video). Recovery was uneventful, and she was discharged on postoperative Day 11. At 1-year follow-up, she remained without recurrence (Panel F).