Anomalous aortic origin of the coronary artery with an inter-arterial course has been associated with sudden cardiac death. The intramural course (the passage of the coronary artery within the aortic wall) has been described as a morphological substrate associated with an increased risk of myocardial ischemia. As previously noted, not all anomalous inter-arterial coronary arteries have an intramural segment.1 According to previous publications, patients with anomalous coronary artery and intramu…