The understanding of normal cardiac anatomy as well as its variations is crucial in the interpretation and reporting of cardiac CT. This chapter will overview normal coronary anatomy and follow with anomalous coronary variations. Cardiac CT can be used to risk stratify anomalous coronary arteries into malignant and benign subtypes. Beyond coronary arteries, the chapter delves further into identification of congenital heart disease, inclusive of congenital intracardiac shunts (atrial and ventricular septal defects, patent ductus arteriosus) as well as surgically created shunts such as Fontans.