Successful repair of left ventricular (LV) pseudoaneurysm after mitral valve replacement (MVR) is uncommon, with delayed onset showing particularly high mortality. We report a case of delayed LV pseudoaneurysm onset after MVR reoperation. The patient had unique clinical symptoms, including coronary ischemia due to compression of the left main coronary artery by the aneurysm. Surgical repair was done using hypothermic circulatory arrest via left thoracotomy. The patient has experienced no cardiac events or pseudoaneurysm recurrence in the 7 years since surgery.