Sequestration of the left coronary artery from the aorta

A patient with the left coronary artery isolated from the ascending aorta is discussed. This is the seventh case described and the third diagnosed preoperatively. In contrast to other patients she had predominant aortic incompetence and was much older (52 years compared with the other patients, all younger than 25 years). She also had two angiograms demonstrating progressive isolation of the coronary artery with time. The patient was managed by aortic valve replacement. It is our belief that the condition is acquired and resulted from fusion of the free edge of the aortic valve leaflet to the supravalvar ridge secondary to an inflammatory process.