Abstract
A thirty nine year old woman presented with ischaemic chest pain caused by a saccular aneurysm of the left coronary sinus of Valsalva. Over the next two weeks there was rapid dilatation of the aneurysm which led to left coronary artery compression and death from a massive myocardial infarction. It is suggested that early repair should be considered in patients with saccular aneurysm at this site, but only in the context of other management priorities.