High anomalous origin of both coronary arteries in a patient with aortic valve disease.

High anomalous origin of both coronary arteries is extremely rare. We report the case of a patient with a right coronary artery that originated from the left surface of the ascending aorta approximately 25 mm above the sinotubular junction and a left coronary artery that originated from the sinotubular junction close to the non-left commissure. The patient also had persistent left superior vena cava. We diagnosed the anomaly preoperatively using 64-slice multidetector computed tomographic angiography. The detailed imaging information helped us to avoid coronary artery injury and perform the operation safely with adequate myocardial protection.