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Fig. 1F —9-year-old girl with Amplatzer septal occluder (AGA Medical Corporation) in good position. See also Figs. S1G-S1K, cine loops, in supplemental data. Global multiplanar reformation image of coronary arteries shows malignant coronary anomaly. Right coronary artery arises from left sinus of Valsalva with interarterial course (arrowheads). High-pressure compression between aorta (Ao) and right ventricular outflow tract (RVOT) would expose patient to risk of sudden death during vigorous exercise. Whole-heart approach is important during interpretation because atrial septal defect can be combined with other congenital cardiac anomaly. AL = anterior leaflet, CRX = circumflex artery, LAD = left anterior descending coronary artery, RA = right atrium, RCA = right coronary artery.