A Hole and One

•ASDs are the second most common CHD in the adult population.•ASDs and coronary artery anomalies have a wide range of clinical presentations.•Indications for intervention depend on the presentation and echocardiographic criteria.•Anatomic risk assessment of coronary artery anomaly is performed using CT angiography.•RV dilatation may regress after closure of ASD despite the age of the patient. ASDs are the second most common CHD in the adult population. ASDs and coronary artery anomalies have a wide range of clinical presentations. Indications for intervention depend on the presentation and echocardiographic criteria. Anatomic risk assessment of coronary artery anomaly is performed using CT angiography. RV dilatation may regress after closure of ASD despite the age of the patient.