A female patient aged 17 years old presented with dyspnea grade III with no chest pain. The patient has Marfan Syndrome, and there was a history of mitral valve repair six years ago. Echocardiography showed an ejection fraction of 55%, severe aortic regurgitation, dilatation of the ascending aorta, and moderate tricuspid regurgitation. CT scan showed an ascending aortic aneurysm (92 mm in its maximum diameter) with dissection flap (Figure 1A and B). We performed a Bentall operation with an axillary cannulation (Figure 1C). The postoperative course was complicated with bleeding requiring re-exploration, and the patient was discharged with stable hemodynamics after 20 days. Postoperative CT scan showed normal size aorta (Figure 1D). This case shows that ascending aortic aneurysm in Marfan patients can reach a huge size, which is rarely reported. Additionally, the aneurysms can silently dissect without causing chest pain.

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