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Aberrant origin of the left coronary artery with associated aortic stenosis.

Many variations of the aortic origin of the coronary arteries are recognised.' Until recently these have been reported infrequently and usually discovered during necropsy.2 The widespread use of coronary arteriography, however, has led to more frequent detection of the anomalies during life. Anomalous origin of the left coronary artery from the right sinus of Valsalva is rare, having been found in one series in 1:2000 angiograms.3 It is important that this condition is recognised, as origin of the coronary arteries from the right sinus of Valsalva is associated with an increased risk of sudden death24 and may have specific implications for the surgeon when associated with valvular or congenital heart disease. We report such a case associated with critical aortic stenosis. Although several investigators have reported anomalous left coronary artery origin and mitral valve disease,5 the association of anomalous left coronary artery origin and appreciable aortic stenosis is exceedingly rare.