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Figure 2 Transthoracic echocardiography from a short-axis plane in a patient with anomalous origin of the left coronary artery from the right sinus of Valsalva and an intramural course of the anomalous coronary. The two-dimensional image (A) shows the anomalous left main coronary artery running intramurally within the anterior aortic wall (small arrows) between the aorta (Ao) and pulmonary artery (PA) before exiting the wall in the left sinus of Valsalva and giving rise to the left anterior descending coronary branch (LAD). Color Doppler imaging (B) shows the linear diastolic flow of the anomalous coronary within the anterior aortic wall (arrow); the blue color signal confirms anomalous coronary flow away from the transducer, consistent with the coronary originating from the right sinus and coursing towards the more posteriorly positioned left sinus. After surgical unroofing of the intramural segment (C), a large neo-orifice has been created in the left sinus (arrow) giving rise to the left coronary system. For the accompanying videos corresponding to Figure 2 (Videos 3 and 4), please see the July 2 issue of JACC at www.cardiosource.com/jacc.html.