Congenital anomalies of the coronary arteries

doi:10.1016/0002-9149(70)90016-0

The American Journal of Cardiology

Volume 25, Issue 4, April 1970, Pages 474-479

https://doi.org/10.1016/0002-9149(70)90016-0 Get rights and content

Abstract

The coronary arteries, like other organ arterial patterns in the body, are subject to congenital variations of both minor and major consequence. This paper presents a review of these variations based upon a series of 224 cases. There are three basic categories. First, minor anomalies in which there is a variation of the origin of the vessels from the aorta and the distal circulation is normal. Second, major anomalies in which there is an abnormal communication (arteriovenous) between an artery and a cardiac chamber or an abnormal origin of a major coronary artery from the pulmonary artery. Third, secondary anomalies in which the coronary arterial variation probably represents a circulatory response to the primary intracardiac pathologic defect. Each category is discussed in detail with reference to the specific anomalies and illustrated with examples from our study.

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Coronary Artery Anomalies – State of the Art Review
2023, Current Problems in Cardiology
Coronary artery anomalies (CAAs) comprise a wide spectrum of anatomic entities, with diverse clinical phenotypes. We present a case of an anomalous right coronary artery arising from the left aortic sinus with an interarterial course, a potentially fatal condition that can precipitate ischemia and sudden cardiac death. CAAs are increasingly detected in adults, mostly as incidental findings in the course of cardiac evaluation. This is due to the expanding use of invasive and noninvasive cardiac imaging, usually in the work-up for possible CAD. The prognostic implications of CAAs in this group of patients remain unclear. In AAOCA patients, appropriate work-up with anatomical and functional imaging should be performed for risk stratification. An individualized approach to management should be adopted, considering symptoms, age, sporting activities and the presence of high-risk anatomical features and physiologic consequences (such as ischemia, myocardial fibrosis, or cardiac arrhythmias) detected on multimodality imaging or other functional cardiac investigations. This comprehensive and up to date review seeks to crystallize current data in the recent literature, and proposes a clinical management algorithm for the clinician faced with the conundrum of managing such conditions.
Coronary artery anomalies evaluation with cardiac computed tomography: A review
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Coronary artery anomalies involve either their origin, course, or termination of the vessel. Coronary artery anomalies are congenital and relatively few develop symptoms, which can include potentially serious effects like arrhythmia, chest pain, syncope, myocardial infarction, or sudden death. Conventional coronary angiography has been used extensively in the past few decades for evaluation of coronary anomalies. With recent advancements in the software and hardware, noninvasive nature, and excellent temporal and spatial resolution; coronary computed tomographic angiography (CTA) is now the mainstay in the diagnosis of coronary arterial anomalies. Many studies have shown better performance of cardiac CTA compared to invasive angiography in detection of anomalous coronary arteries.
Les anomalies des artères coronaires concernent l'origine, le parcours ou la terminaison du vaisseau. Ces anomalies sont congénitales et relativement peu de personnes développent des symptômes, qui peuvent inclure des effets potentiellement graves comme l'arythmie, les douleurs thoraciques, la syncope, l'infarctus du myocarde ou la mort subite. La coronarographie conventionnelle a été largement utilisée au cours des dernières décennies pour évaluer les anomalies coronaires. Grâce aux récentes avancées en matière de logiciels et de matériel, à la nature non invasive et à l'excellente résolution temporelle et spatiale, l'angiographie coronarienne par tomodensitométrie est désormais le pilier du diagnostic des anomalies coronariennes. De nombreuses études ont montré que l'angiographie par tomodensitométrie est plus performante que l'angiographie invasive pour détecter les anomalies des artères coronaires.
Anomalous origin of coronary artery from the opposite aortic sinus of Valsalva-a single center experience with a therapeutic conundrum
2021, Indian Heart Journal
Citation Excerpt :
Male predominance (M: F 4:1) in the study can be explained by the fact that more males underwent angiography in our center. In previous studies, the most frequent coronary anomaly was the origin of the circumflex artery from the right aortic sinus.4,6,9 However, in the present study though, origin of the RCA from the left aortic sinus was the most common anomaly at 68.9%.
Background: Coronary artery anomalies are rare congenital abnormalities, most often found incidentally on conventional coronary angiography and CT angiography (CTA). CTA better delineates the origin and course of anomalous coronaries. Anomalous origin of coronary artery from the opposite aortic sinus of Valsalva (ACAOS) has a prevalence of 1% with a very few having an interarterial (malignant) course. There is limited literature, especially in the Indian population, dealing with this topic.
Methods: In this retrospective observational study, angiographic data of 8500 consecutive patients from June 2011 to December 2019 at a large tertiary care hospital in western India was analyzed. Patients diagnosed with ACAOS underwent CTA for delineation of the exact anatomy. Those with a non-malignant course with evidence of ischemia clinically or on stress myocardial perfusion imaging (MPI), underwent PCI. Others with a non-malignant course were medically managed. Patients with malignant (interarterial) course were revascularized by coronary artery bypass graft (CABG) surgery in case of LCA involvement or positive MPI test. Asymptomatic patients with negative MPI were managed medically. Clinical follow-up over 12 months of patients undergoing PCI and those with a malignant course showed no major adverse cardiovascular events (MACE).
Results: Of the 8500 patients studied, 74 (0.87%) had ACAOS. Of these, 51 (68.9%) patients had anomalous origin of right coronary artery (RCA) from the left aortic sinus, 21 (28.4%) had anomalous origin of the circumflex artery (Cx) from the right aortic sinus and two patients (2.7%) had an anomalous origin of the left main coronary artery (LCA) from the right aortic sinus. Interarterial course was found in five (6.7%) patients. Of these, four patients underwent CABG-one asymptomatic patient with LCA from right aortic sinus and three with positive MPI in anomalous RCA. All five patients with malignant course and ten patients who underwent PCI were free of MACE over 12 months’ clinical follow up.
Conclusions: ACAOS is a rare anomaly and if interarterial course is excluded, then PCI is feasible in selected cases with significant stenosis. Patients with malignant course with inducible ischemia or LCA involvement should undergo surgical revascularisation.
Coronaro-cameral fistula, case report and review of the literature
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2024, European Journal of Case Reports in Internal Medicine

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^☆: This paper was awarded first prize in the Young Investigator's Award competition, at the annual meeting of the American College of Cardiology, New York, February 28, 1969.

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ReviewCongenital anomalies of the coronary arteries☆

Abstract

J Thorac Cardiovasc Surg

Anomalies of the coronary arteries and their clinical significance

Circulation

Anomalii vonechnykh arterii serdsa

Arkh Pat

Coronary artery anomalies

Circulation

Review
Congenital anomalies of the coronary arteries☆