High origin of the left and anterior origin of the right coronary artery (Subgroup 3). In this complex case a high origin of LM above the commissure between right and left coronary sinuses within the aortic root was reported. Furthermore RCA originates in a somewhat anterior position. Image A (Volume Rendering Technique) depicts the acute angle of LM (white arrow) above the aortic cusp (grey arrow), which is suspected as a possible mechanism of ischemia. In image B the close proximity of both coronary ostia in ICA is shown. Curved Multiplan Reformatting (Image C) displays further proximal course of LM and RCA between aorta and pulmonary artery. Note the ovoid cross sections of both intramural courses (cross-sectional images of RCA and LM), which is suspicious of lateral compression that may result in further compression during each systole especially under exercise conditions. DB: diagonal branch; LCX: left circumflex ramus; LA: left atrium; LAD: left anterior descending coronary artery; LM: left main coronary artery; PA: pulmonary artery; RCA: right coronary artery.