ISOLATION OF THE LEFT CORONARY-ARTERY OSTIUM BY AN AORTIC CUSP ATTACHMENT - A RARE CAUSE OF MYOCARDIAL-ISCHEMIA

A 34-year-old woman experienced a 3-month history of recurrent chest p ain on exertion. Extensive investigation, including coronary angiograp hy, revealed severe aortic incompetence with suspicion of single-vesse l coronary disease. At operation the aortic valve was tricuspid but th e left coronary cusp was adherent to the aortic wall, resulting in iso lation of the left coronary artery with only a tiny communication with the aortic lumen. The three cusps were excised. An aortic valve repla cement was performed with an aortic homograft. The postoperative cours e was uneventful and myocardial ischemia was totally relieved.