Unusual late presentation of asymptomatic diaphragmatic hernia following ventricular assist device explantation

The role of left ventricular assist device (LVAD) in treatment options of congestive heart failure is becoming more important and the widespread application is imminent. There are, however, some serious complications associated with LVAD, which make patient management more challenging. We report a rare surgical case of asymptomatic diaphragmatic hernia, which was diagnosed 8.5 years after heart transplantation and LVAD explantation. A left mini (7 cm), muscle- and nerve-sparing thoracotomy was performed, and we found the splenic flexure of the colon herniated into the left pleural space through a small, circumferential defect of the diaphragm ( approximately 4 cm in diameter) created for the inflow cannula of LVAD. The hernia was reduced and the defect was repaired.