A right coronary artery that arises anomalously and then courses between the aorta and pulmo- nary artery with evidence of myocardial ische- mia.1179 1182 (Level of Evidence: B) Class IIb 1. Coronary revascularization may be reasonable in patients with a LAD coronary artery that arises anomalously and then courses between the aorta and pulmonary artery. (Level of Evidence: C) Several variations and anatomic courses of anomalous coro- nary arteries have been described, some benign and others associated with sudden cardiac death. The most life- threatening variants involve anomalous origin of the left main coronary artery from the right sinus of Valsalva or of the right coronary artery from the left sinus of Valsalva, after which the anomalous artery travels to its normal area of perfusion between the ascending aorta and the main pulmonary artery. 