[Coronary artery anomalies associated with bicuspid aortic valve]

Bicuspid aortic valve (BAV) is the most common congenital heart disease. It is often associated with aortic abnormalities and, more rarely, with coronary anomalies that may influence surgical strategy. We describe a 38-year-old patient with a Sievers type I BAV. Coronary CT angiography revealed an abnormally high proximal origin of the right coronary artery, with a 10 mm ectatic dilation at its origin followed by a return to normal caliber. This feature prompted a change in operative strategy: mechanical aortic valve replacement instead of a Ross procedure, more distal aortic clamping, and a «lazy-S» aortotomy. The procedure was completed without complications. Coronary anomalies are more frequent in patients with BAV than in the general population. Their preoperative identification is essential to prevent intraoperative complications. Multimodal imaging plays a key role in optimizing surgical planning in line with current recommendations. Coronary anomalies associated with BAV should be systematically screened for before any valve surgery. This case highlights the importance of thorough preoperative assessment and appropriate technical adaptation to ensure operative safety.