Intramural left main coronary artery unexpectedly encountered during aortic root replacement.

We present an intramural left main coronary artery, unexpectedly encountered during aortic root replacement in a truncus arteriosus patient. Given the severely limited orifice, we opted to unroof the intramural portion of the left main coronary artery prior to implantation as a button. Until now there have been no reports in the literature describing unroofing an intramural coronary artery prior to reimplantation in an aortic root replacement operation.