This patient's left coronary artery arises from the right coronary cusp and courses between the aorta and pulmonary artery. This is known as an interarterial course, sometimes referred to as a malignant course. This abnormality can potentially lead to life-threatening complications, such as myocardial ischemia, arrhythmias, or sudden cardiac death, particularly during exercise or periods of increased demand.

In anomalous coronary arteries with interarterial course, the morphology of the vessel also is a determinant of likely outcomes. Patients whose vessels have a particularly acute angle at the ostium or patients where the coronary artery has an intramural course (e.g. travels within the wall of the aorta) are more likely to suffer from complications.