An 84-year-old male affected by correct transposition of the great arteries was admitted for an acute coronary syndrome, complicated by pulmonary edema. Coronary angiography showed a unique coronary anomaly: a common trunk, situated in the right sinus of Valsalva, gave rise to the left anterior descending coronary artery (LAD), the right coronary artery and an atrial branch; the circumflex coronary artery originated separately but close to the common trunk. A tight stenosis in the proximal LAD was successfully treated by percutaneous coronary intervention.