Emergency aortic valve replacement with double aorto-coronary bypass surgery was performed to treat severe intractable congestive heart failure in an 82-year-old man. Mild circumflex and left anterior descending artery lesions were present and the pressure gradient across the aortic valve was 80 mmHg despite a low cardiac output. The preoperative anteroseptal akinesia seen by two-dimensional echocardiography was normalized after surgery. Thus, even in patients with segmental left ventricular dysfunction, tight aortic stenosis might be present when concomitant mild ischemic heart disease is present.