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The present article describes a case involving a 74-year-old woman who presented with atypical chest pain and was found to have a giant aneurysm of the left sinus of Valsalva. Computed tomography coronary angiography performed before surgery showed a left main stem arising from the superior aspect of the left coronary sinus (stretched superiorly over, but not within, the aneurysm sac). The patient underwent surgery and an aortic valve replacement and root graft were performed. Intraoperatively, there was a progressive reduction in systemic arterial pressure and cardiac output disappeared, culminating in ventricular fibrillation, which was believed to be due to ischemia induced by the stretching of the native coronary arteries over the roof of the aneurysm sac. Therefore, the patient underwent coronary artery bypass grafting with revascularization of the left-sided system. The authors suggest that preoperative assessment, including noninvasive assessment of myocardial ischaemia, should be part of the work-up.