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the circumflex, a transatrial approach would no doubt be ideal. In cases similar to ours, a direct approach through a left thoracotomy is a good alternative because the circumflex artery can be clearly visualized and protected. Moreover, most patients do not have significant mitral regurgitation and might not require an additional mitral valve procedure.Our approach, which is based on the relationship of the circumflex coronary artery to the neck of the aneurysm as demonstrated on a preoperative angiogram, appears to be safe and will result in significant reduction in mortality and morbidity in managing this rare and difficult condition, particularly in parts of the world outside Africa.

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