LAUSR

A 49-year-old man with a transthoracic echocardiographic diagnosis of aortic stenosis with bicuspid aortic valve and dilated ascending aorta was referred for computed tomography angiography that revealed a bicuspid aortic valve with thickened noncalcified leaflets (Figure 1A). There was no raphe and the coronary artery origins were from the respective sinuses. The left sinus was relatively more ectatic and projected inferiorly. The left main coronary artery segment was absent with separate origins of the left anterior descending and left circumflex arteries from the left sinus (Figure 1B). Secondary to left sinus ectasia and the posterior origin of the left circumflex artery, there was an acute angle of take-off producing a slit-like ostium (Figure 2). The other coronary arteries did not show any obstructive disease. No left ventricular regional wall motion abnormality, wall thinning, or subendocardial hypodensity was noted.