Anomalous origin of the coronary arteries may limit the applicability of aortic valve sparing techniques during root replacement. We report a case of a right coronary artery that originated from the left sinus and coursed intramurally in a patient with an aortic root aneurysm. Attention to the anatomic relation between the anomalous coronary and aortic root structures and right coronary safety button reconstruction allowed safe aortic root replacement while preserving the native aortic valve.
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