An 88-year-old woman with critical aortic stenosis was evaluated for transcatheter aortic valve replacement (TAVR) with the Sapien (Edwards Inc., Irvine, California) balloon-expandable aortic bioprosthesis. Pre-operative coronary angiography (A, Online Video 1) revealed a single coronary ostium with an anomalous left main coronary artery (LMCA) arising from the proximal right coronary artery in the right coronary cusp. Cardiac computed tomography confirmed an interarterial course of the anomalous LMCA (B, Online Video 2). A coronary wire was placed in the left anterior descending artery to serve as protection for the LMCA during balloon valvuloplasty and TAVR, with the potential for rapid stenting if necessary (C, red arrow, Online Video 3). During valvuloplasty, aortography confirmed patency of the LMCA (C, blue arrow) with an inflated balloon across the aortic valve (C, black arrow). Post-TAVR angiography revealed continued patency of the LMCA and further elucidated the relationship between the aortic annulus, as demonstrated by the Sapien valve (D, blue arrow, Online Video 4), the right ventricular outflow tract (D, red arrow), and the course of the anomalous LMCA (D, black arrow).