Left Main Coronary Artery Aneurysm Surgical Treatment by "No-Touch" Technique With Concomitant Left Ventricular Assist Device.

A 57-year-old man with a known left main coronary artery aneurysm presented with acutely decompensated heart failure and ventricular tachycardia secondary to ST elevation myocardial infarction. Transthoracic echocardiography identified a left ventricular ejection fraction <20% and anterior/septal wall akinesis. Left-sided cardiac catheterization revealed left anterior descending coronary artery occlusion. After the patient was placed on extracorporeal membrane oxygenation, delayed left ventricular distention developed, requiring further surgical intervention. Because of immense size, a novel "no-touch" approach was taken to the left main coronary artery aneurysm; the patient concomitantly underwent ventricular tachycardia ablation and continuous-flow left ventricular assist device implantation.