Background: Aortic complications can occur during left ventricular assist devices (LVAD) insertion and its treatment remains challenging. Percutaneous aortic interventions can be an alternative to surgery in such high-risk cases.

Case summary: We present a patient with idiopathic dilated cardiomyopathy and advanced heart failure requiring LVAD insertion as a bridge to transplant, who developed an aortic pseudoaneurysm below the anastomosis of the LVAD tube. He was treated by percutaneously coiling under contrast-enhanced transoesophageal echocardiographic (TOE) guidance and safely reached destination (heart transplantation) a year later.

Discussion: LVADs provide haemodynamic support for patients with advanced heart failure waiting for heart transplantation. Although uncommon, aortic complications can develop after LVAD insertion and are life-threatening. Percutaneous aortic interventions are feasible in such cases to promote thrombosis and shrinkage of aneurysmal spaces, hence potentially reducing the risk of sudden death. Contrast-enhanced TOE can be easily and safely used to both monitor the intervention by improving anatomic target definition, guide and wire positioning, and assess early results.