**6.1.4 Angiographic diagnosis of anomalous connection with the non-coronary sinus (type IV)**

Angiographic diagnosis of anomalous origin from the non-coronary sinus is always challenging with frequent difficulties of a selective canulation. Moreover, the interpretation of angiographic views is often ambiguous and needs complementary imaging.

#### **6.1.5 Angiographic diagnosis of anomalous connection above the sinotubular junction (type V)**

Difficulties in identifying a high take-off from the aorta by conventional angiography are non unusual. Many catheters, similar to these used for saphenous vein grafts, are often required. Moreover, an initial intramural course may make selective injections more difficult. Finally, the distinction between a normal variant of origin and a high take-off at least 10 mm above the sinotubular junction is ambiguous in most cases. Once again, the coronary CT angiography will be able to delineate accurately the level of the coronary ostia.
