In June 2015, a 67-year-old female with a long-standing history of asymptomatic critical AS was referred for AVR after new onset of shortness of breath. A preoperative transesophageal echocardiogram showed aortic valve area of 0.6 cm2 with 2+ mitral regurgitation. Cardiac catheterization revealed no significant coronary artery disease and well-preserved left ventricular ejection fraction. She underwent insertion of a 19 mm St. Jude Biocor bioprosthetic aortic valve. Postoperatively patient did well. She was started on warfarin and discharged home. In May 2016, patient experienced shortness of breath with moderate exertion, which was new. She underwent a nuclear stress test (Cardiolite), which was abnormal. Repeat coronary angiography revealed 99% narrowing of the left main coronary artery (LMCA).The left anterior descending artery, left circumflex and right coronary artery (RCA) did not reveal any discrete stenosis. After consultation with the cardiac surgeon and the family, the patient underwent urgent primary stent deployment of LMCA.