**12.1 Management**

First of all, the coronary abnormality should be clearly defined with a correct interpretation of ectopic origin, initial course regarding to aortic wall, and ectopic course regarding to adjacent structures. Uncertain diagnosis or high-risk ANOCOR need always complementary imaging investigation allowing a useful confrontation. All cardiologists and radiologists are not familiar with the large spectrum of congenital coronary abnormalities, and the opinion of a practitioner experienced in the field of ANOCOR should be mandatory before decisionmaking. Recent investigation conducted by the Anomalous Coronary Artery Working Group of the Congenital Heart Surgeon's Society showed a heterogeneous management of young adults with ANOCOR associated with a preaortic course (Brothers et al., 2009). In 36th Bethesda Conference focused on trained athlete with an identified cardiovascular abnormality, detection of coronary anomalies of wrong sinus origin in which a coronary artery passes between the aorta and pulmonary artery should result in exclusion from all participations in competitive sport (Graham et al., 2005). Participation in all sport 3 months after successful operation would be permitted for an athlete without ischemia, ventricular or tachyarrhythmia, or dysfunction during maximal exercise testing was another recommendation of the 36th Bethesda Conference. As previously mentioned, presence of symptoms, high-risk anatomical features and young age are the main criteria requiring a special attention in order to prevent a sudden cardiac death. Even if false-negative cases are frequent, stress exercise tests with nuclear imaging are necessary in this population exposed. More aggressive investigations, such pharmacological tests simulating extreme exercise have been suggested but are not without dangers (Angelini et al., 2003). According to current understanding, only an intramural segment seems to be clearly related with a highrisk of sudden death, and the best means in identifying intramural segment is IVUS. The definition of a cut-off age in deciding a population as high-risk remains difficult in practice. If the literature gives relatively clear information in < 30-year old and > 50-year old patients, the management of patients between 30 and 50 years of age is often problematic. Restriction of activity, particularly competitive sport and intensive exertion, is often recommended if a surgical repair is not indicated. Medical treatment with essentially beta-blockers is sometimes associated. Due to possible but rare late deaths or subclinical myocardial ischemia after surgical repair of ANOCOR, long-term follow-up with regular cardiovascular evaluation is needed (Brothers et al., 2007, Brothers et al., 2009). Presence of significant atherosclerotic coronary disease or valvular disease requiring cardiac surgery permits sometimes a concomitant treatment of a high-risk ANOCOR. Furthermore, identification of ANOCOR is crucial before aortic surgery in order to avoid an injury of the ectopic vessel or to compress along its course by a valvular prosthesis.
