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Anomalous aortic origin of a coronary artery with an intraseptal course of the left coronary artery is a rare anomaly that can cause myocardial ischemia. Surgical technique known to improve outcome is lacking because of the challenging complexity of the anatomy. We herein describe a novel surgical approach in a young athlete with myocardial infarction and ongoing ischemia. Supraarterial myotomy of the intraseptal segment through a right ventriculotomy and direct reimplantation of the left coronary artery were performed successfully. After postoperative resolution of inducible myocardial hypoperfusion, the patient was allowed to return to competitive activities with no further symptoms.