Anomalous Aortic Origin of a Coronary Artery (AAOCA)

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Anomalous aortic origin of a coronary artery (AAOCA) is treated by the multidisciplinary Coronary Anomalies Program at Texas Children’s Hospital. We are dedicated to the diagnosis and management of patients with congenital coronary anomalies including AAOCA. 

What is anomalous aortic origin of a coronary artery (AAOCA)?

Normal anatomy of the origin of the coronary arteries

The coronary arteries are vessels that arise from the aorta (the biggest vessel in the body) and provide blood supply to the heart. There are usually two: the left and right coronary arteries. The vessels arise from one of three outpouchings of the aorta called sinuses of valsalva. Anomalous aortic origin of a coronary artery (AAOCA) is a cardiac abnormality present at birth in which the origin or course of a coronary artery that arises from the aorta is atypical.

AAOCA is the second leading cause of sudden cardiac death (SCD) in young athletes in United States.

People with AAOCA are typically asymptomatic. The first manifestation of the disorder can be sudden cardiac arrest (SCA) or SCD in nearly half of those affected with certain types of this condition.

Types of AAOCA


The figure to the right shows the usual types of AAOCA we evaluate and manage in our program, among other types of anomalies, such as myocardial bridge.

The left hand panel shows AAOCA that have an interarterial course. The interarterial course is a condition in which the coronary artery travels between the two great arteries – the aorta (the artery that takes blood to the body) and the pulmonary artery (the artery that takes blood to the lungs to receive oxygen).

The graphic shows anomalous coronary arteries that have an intramural course, in addition to an interarterial course. The intramural course is a condition in which the first part of the coronary artery has grown within the aortic wall and may increase risk for ischemia, which is decreased blood flow to the heart muscle.  

A particular type of AAOCA is the one that includes an intraseptal course, which means that the anomalous coronary travels inside the heart muscle for a specific length before surfacing the heart. Patients may be asymptomatic (without symptoms) but some may experience symptoms.

During your child’s clinic visit, the cardiology provider will go over (in great detail) the type of AAOCA your child has.

CT scan of the left coronary
artery with an intraseptal course

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