Management of Ruptured Left Ventricular Outflow Tract

Left ventricular outflow tract pseudoaneurysm is a potentially fatal complication after aortic root replacement. Challenges surrounding multiple reoperations on the aortic root include sternal reentry, bleeding, valve positioning, compression of coronary arteries, and navigating concomitant interventions. We present a 27-year-old patient with mechanical valves in the aortic and mitral positions and a left main coronary artery drug-eluting stent for left main compression after being diagnosed with rheumatic heart disease at age 16. She underwent a fourth redo modified Bentall procedure with a homemade mechanical composite graft for the contained rupture of an left ventricular outflow tract pseudoaneurysm.