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Figure 4 Diagram showing the unroofing technique in a patient with anomalous origin of the left coronary artery from the right sinus of Valsalva with an intramural course. The normally positioned right coronary artery orifice and the anomalous left coronary artery orifice can both be seen arising from the right sinus (A). The intramural segment of the anomalous coronary is unroofed (B) to create a neo-orifice in the left sinus (C). The base of the commissure between the right and left cusps is sometimes involved in the unroofing procedure, requiring resuspension (C).