A 34-year-old woman experienced a 3-month history of recurrent chest pain on exertion. Extensive investigation, including coronary angiography, revealed severe aortic incompetence with suspicion of single-vessel coronary disease. At operation the aortic valve was tricuspid but the left coronary cusp was adherent to the aortic wall, resulting in isolation of the left coronary artery with only a tiny communication with the aortic lumen. The three cusps were excised. An aortic valve replacement was performed with an aortic homograft. The postoperative course was uneventful and myocardial ischemia was totally relieved.
Amrani, M., Rubay, J., Pirenne, B., Col, J., & Dion, R. (1994). Isolation of the left coronary artery ostium by an aortic cuspattachment: a rare cause of myocardial ischemia. European Journal of Cardio-Thoracic Surgery, 8(12), 663-664. https://doi.org/10.1016/S1010-7940(05)80177-0 (Original work published 1994)