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An anomalous origin of the coronary artery is an infrequent but significant cause of myocardial ischemia andsudden death. A left coronary artery arising from the right sinus of Valsalva is of clinical value due to its possibleassociation with sudden cardiac death, particularly when it courses between the aorta and pulmonary trunks.Nevertheless, it is amenable to appropriate surgical intervention, thereby emphasizing the importance of clinicalsuspicion and timely identification. We report the case of a 14-year-old boy, who presented with acute myocardialinfarction of the anterior wall, with an anomalous left coronary artery originating from the right sinus of Valsalva.Transthoracic echocardiographic evaluations of the anomalous origin of the coronary artery and Doppler findingof a ‘finger-tip phenomenon’, which can be observed under circumstances of myocardial bridging, allowed thediagnosis of this anomaly. (Korean Circulation J 2007;37:39-42)