The Anomalous Aortic Origin of Coronary Arteries (AAOCA) is a rare congenital condition, that can induce cardiac ischemia during strenuous activity, which is a critical risk factor for sudden cardiac death, especially in young athletes and soldiers, but also a serious threat to non-athletes [1,2]. Despite Computed Tomography (CT) providing accurate anatomical details, evaluating ischemia through invasive methods exhibits limited sensitivity and specificity, highlighting the necessity of a multimodal strategy for effective risk assessment. Patient-specific computational models, derived from CT imaging, offer a valuable tool in structural simulations to enhance our understanding of the biomechanical mechanisms driving AAOCA and improve patient management [2]. However, neglecting the in-vivo pre-deformation of anatomical structures and treating image-based reconstructions as stress-free can generate unrealistic stress/strain predictions, particularly in cases of significant deformation [3,4]. To address this, our study focused on determining the zero-stress configuration of the aorta and coronary arteries in AAOCA patients using a CAD-FEM approach rooted in Inverse Design [5]. We utilized patient-specific CAD models of the aorta and coronaries, reconstructed from diastolic CT scans reflecting the patient's anatomy under physiological blood pressure during imaging, to derive this zero-stress state. Potential zero-stress geometries were defined by radially shifting the inner and outer surface profiles inward. Subsequently, the diastolic pressure was applied as a uniform load to identify the geometry that minimized the point-wise distance compared to the CT-derived model. Starting from this zero-stress configuration, further simulations under increasing pressure loads were conducted to evaluate the enlargement or narrowing of any anomalous coronary segments, complementing clinical evaluations. Our findings indicate that a 3% scaling factor allows for accurate determination of the zero-stress configuration, a result validated by comparing internal cross-sectional areas of aorta and coronaries between the simulated and CT-derived configurations at diastolic pressure.