SUMMARYA 52-year-old man underwent two-dimensional echocardiogram which showed moderate to severe aortic regurgitation (AR) and dilated ascending aorta. CT angiography (CTA) showed dilated ascending aorta (5 cm) and transoesophageal echocardiogram revealed bicuspid aortic valve. He underwent cardiac catheterisation which revealed triple vessel aneurysmal disease of the left anterior descending, left circumflex and right coronary artery. The patient underwent aortic graft placement for ascending aortic aneurysm and aortic valve replacement with a Saint Jude valve for severe AR. There was no history or stigmata of Kawasaki disease and workup for coronary artery aneurysm including vasculitis and connective tissue disorders was negative. Histopathology did not reveal evidence of active aortitis or dissection. His aneurysms are being observed by a yearly coronary CTA. We present a rare case of multiple coronary artery aneurysms associated with bicuspid aortic valve and ascending aortic aneurysm. BACKGROUND