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A single coronary artery originating above the left sinus of valsalva is extremely rare and may be related with sudden cardiac death. We report on a 61-year-old man of surgically treated single coronary artery presenting unstable angina, which confirmed by aortography (Fig. 1) and three-dimensional coronary computed tomography (Fig. 2). Fig. 1. On aortography, a common trunk was found to originate above the left sinus of valsalva; the right coronary artery could not be visualized. Fig. 2. (A) Three-dimensional coronary computed tomography showed the common trunk and the unusual course of the right coronary artery between the aorta and pulmonary artery, with an acute angle in its proximal part (arrow). There was a significant stenosis at the ostium of the left anterior descending artery (asterisk), which was suspected as a culprit lesion. CABG was carried out successfully with saphenous vein graft to RCA and left internal mammary artery to mid LAD. (B) Three-dimensional coronary computed tomography performed three months later showed good patency of the saphenous vein graft.