Common Coronary Anomalies on MDCT

Coronary artery anomalies are rare, and the incidence is around 1 to 2% in the general population. Majority of the patients are asymptomatic and detected while investigating another clinical issue. A few anomalies may be life-threatening due to the malignant course with potential for ischemia and even sudden death. Multidetector computed tomography (MDCT) has high accuracy in detecting these anomalies because of volume rendering (VR) and multiplanar reconstruction (MPR). ‘High take-off’, origin of the coronary artery from the opposite or noncoronary cusp with anomalous course and coronary artery fistula are three most frequent anomalies. MDCT can be a useful screening tool in the study of coronary anomalies.

INCIDENTALLY DETECTED MALIGNANT RIGHT CORONARY ARTERY ORIGINATING FROM LEFT CORONARY SINUS: A RARE CASE REPORT

BACKGROUND: Congenital coronary artery anomalies are rare and are usually an incidental ?nding. The incidence of coronary anomalies was reported as 1.3% in a large number of patients undergoing coronary angiogram1. In this report we present a patient with a malignant right coronary artery (RCA) originating from left coronary sinus CASE REPORT:A 52 year old male came to cardiac OPD in view of ?tness for cataract surgery. He does not have any signi?cant cardiac history or symptoms. Coronary angiogram revealed Anomalous coronary artery arising from left coronary sinus with critical 99% lesion in the Mid RCA. The patient was taken up for Percutaneous transluminal coronary angioplasty and the Mid RCA lesion was addressed. CONCLUSION:The treatment plan for people with Malignant RCA should be based on an interdisciplinary decision made between the treating physician, patient, cardiovascular imaging experts, cardiologists and heart surgeons depending on symptoms, age, anatomic features of ACAOS and ischaemic testing.

Coronary anomalies and anatomical variants detected by coronary computed tomographic angiography in Kashmir, India

Background: Coronary Artery Anomalies (CAAs) presenting in adulthood are rare and associated with adverse cardiac events, including sudden cardiac death. Coronary artery anomaly is the second most common cause of Sudden Cardiac Death (SCD) in young athletes. Cardiac Computed Tomographic Angiography (CTA) is a readily available non-invasive imaging modality that provides high-resolution anatomical information of the coronary arteries. Multi-detector row CT is superior to conventional angiography in defining the ostial origin and proximal path of anomalous coronary branches.Methods: This was a prospective study included 186 patients who underwent coronary CTA from December 2018 to November 2019 in Government medical College, Srinagar on a 256 slice CT. The indications for coronary CTA were an equivocal, or non-diagnostic stress test, atypical chest pain, suspected anomalous coronary, as well as the evaluation of cardiac cause of syncope.Results: Ramus intermedius was the most common anatomical variant seen in 25 patients (13.4%). The prevalence of coronary anomalies in this study was 5.66% including myocarding bridging. The most common anomaly was high take off of coronary artery from sinotubular junction accounting for 1.6%.Conclusions: Coronary Computed Tomographic angiography is much superior in detecting coronary artery anomalies than invasive coronary angiography because of the absence of soft tissue information like as is needed in myocardial bridging. Proper knowledge of the anomalies and their clinical significance is highly important in planning treatment and easing hardships of cardiologists in dealing with them.

Chinese expert consensus on surgical treatment of congenital heart disease (12): Congenital coronary artery anomalies / 中国胸心血管外科临床杂志

@#Congenital coronary artery anomalies include various congenital anatomic anomalies of coronary artery. Severe congenital coronary artery anomalies usually result in ventricular dysfunction, myocardium ischemia, and even sudden death. Hence, understanding the coronary artery anomalies is critically important for the related surgeons to make reasonable strategies. This consensus is based on current literature and opinions of Chinese experts. And we mainly discuss the anatomy, clinical manifestation, diagnosis and treatment of important congenital coronary artery anomalies in clinics including anomalous aortic origin of a coronary artery, anomalous origin of the coronary artery from the pulmonary artery and coronary fistula.

Prevalence and spectrum of coronary artery anomalies in 8021 patients: A single center study in South India

Objective To identify the prevalence of coronary artery anomalies (CAAs) and their subtypes based on Angelini et al. classification in symptomatic yet stable population of South India using 64- slice dual source multi detector CT coronary angiography (MDCT-CA). Methods We retrospectively reviewed reports of 8021 symptomatic patients predominantly South Indians who were referred for CT coronary angiography (CT-CA) to our tertiary cardiac care center in Hyderabad, India from January 2011 to March 2017. Results We identified a total of 838 coronary artery anomalies in 812 patients with a prevalence of 10.09%. 96.9% of patients were older than 30 years of age with a M:F ratio of 1.39:1. Coronary artery disease (CAD) was seen in 61.5% of these patients. Among these anomalies, myocardial bridging (MB) was the most common anomaly followed by anomalous location of coronary ostium at improper sinus (ACOIS). Conclusion There is no significant difference in prevalence of CAAs (including and excluding MB) in Indian and World population. CAAs were more common in males than females and most of these patients remain asymptomatic during first three decades of their life. Myocardial bridging is the most common anomaly detected by MDCT-CA followed by ACOIS. Right coronary artery (RCA) arising from left coronary sinus (LCS) is the most commonly encountered ACOIS.

Miocardiopatía de takotsubo y la arteria coronaria única: una combinación excepcional / Takotsubo cardiomyopathy and single coronary artery: a unique combination

La miocardiopatía de takotsubo es una entidad que clínicamente simula un síndrome coronario agudo, siendo indispensable para su diagnóstico la exclusión de la enfermedad coronaria significativa. Se presenta el caso de una mujer postmenopáusica, quien durante un episodio de migraña desarrolla un cuadro clínico similar a un infarto del miocardio anterior, donde la ecocardiografía durante el evento agudo, orientó hacia el diagnóstico correcto de miocardiopatía de Takotsubo, encontrándose incidentalmente una arteria coronaria única sin enfermedad obstructiva.

Takotsubo cardiomyopathy is a condition that clinically simulates an acute coronary syndrome, thus it remains indispensable for its diagnosis to exclude a significant coronary disease. We present the case of a postmenopausal woman who developed a clinical picture similar to an anterior myocardial infarction during a migraine episode, where the echocardiogram during the acute event oriented towards the correct diagnosis of a Takotsubo cardiomyopathy, incidentally finding a single coronary artery with no obstructive disease.

Clinical analysis of right coronary artery anomalies in 8 children / 中华实用儿科临床杂志

Objective To observe the clinical characteristics and improve the diagnosis and treatment of right coronary artery anomalies in children.Methods The clinical characteristics,laboratory examination,treatment and prognosis were retrospectively analyzed in children with right coronary artery anomalies (complex cardiac anomalies was excluded),who were admitted into Beijing Children's Hospital Affiliated to Capital Medical University from January 2009 to December 2014.Results A total of 8 medical records of children with right coronary artery anomalies,among whom 5 cases were male and 3 cases were female,with a mean age of (7.06 ± 1.37) years old.In these 8 patients,there were 5 patients with right coronary artery originating from left coronary sinus,1 patient with right coronary artery originating from left wall of aorta,1 patient with single left coronary artery type Lipton L Ⅱ,and 1 patient with right coronary artery absence.The main symptoms included chest distress,chest pain and palpitation in elder children,but in infants,the primary symptom was poor feeding.One case of these patients represented syncope.Electrocardiogram of these patients showed ST-T wave changes,sinoatrial block,and sinus arrest.Ultrasonic cardiogram failed to discover the coronary artery anomalies.Four cases showed enlarged left ventricular end-diastolic diameter,and 1 case showed slight decrease of left ventricular ejection function.All 8 patients were given myocardial tonic with limitation in doing exercise,and clinical follow-up studies were conducted for 6 months.Four patients with enlarged left ventricular were treated with Captopril,and 3 patients of them recovered after 3 to 6 months.Two patients with sinus node malfunction were treated with permanent pacemaker implantation in other hospitals.Conclusions Right coronary artery anomaly in children is rare.Patients with cardiac ischemia and sinus node malfunction should be aware of right coronary malformation.64-section multidetector computerized tomography angiography can diagnose right coronary artery anomalies.To patients with right coronary artery anomalies,vigorous exercises should be avoided to decrease adverse cardiac events.

Angioplastía de circunfleja en paciente con doble arteria descendente anterior tipo IV: Propuesta para actualizar la clasificación de Spindola-Franco / Circumflex angioplasty in a patient with type IV dual left anterior descending coronary artery: Proposal for updating the classification of Spindola-Franco

La anatomía normal de las arterias coronarias incluye una serie de variantes respecto a su origen, distribución y recorrido, que hacen que no existan 2 pacientes con coronarias exactamente iguales. La arteria descendente anterior puede tener variantes anatómicas que no afectan el aporte normal de sangre al territorio miocárdico correspondiente. En nuestros 25 años de trabajo y más de 11,000 coronariografías realizadas, sólo habíamos encontrado un paciente con un doble sistema, tipo IV, de la arteria descendente anterior. En este artículo mostramos el caso de una paciente con la anomalía coronaria descrita que presentaba, además, una estenosis severa de la arteria circunfleja que fue tratada exitosamente por vía percutánea. También, se propone una actualización de la clasificación de Spindola-Franco, donde se mantienen los 4 tipos originales y se añaden 7 variantes anatómicas o subtipos.

The normal anatomy of coronary arteries includes a kind of variants with regard to its origin, distribution and route, which makes that 2 patients do not have coronary arteries exactly alike. Left anterior descending artery could have anatomical variations that do not affect the normal supply of blood to the corresponding myocardial territory. In our 25 years of experience, and more than 11,000 coronary angiographies, we have found only one patient with a type IV Classification; dual left anterior descending coronary artery. In this article we show the case of a patient with the described coronary anomaly, presenting a severe stenosis of the circumflex artery which was successfully treated percutaneously. Besides, a proposal for updating the classification of Spindola-Franco is made, where the 4 types previously described were kept invariable, and 7 anatomical variants or subtypes were added.

Compressão extrínseca da artéria coronária esquerda por dilatação aneurismática do tronco pulmonar em adolescente: involução após oclusão cirúrgica de comunicação interatrial seio venoso e plastia redutora do tronco pulmonar / Extrinsic compression of left main coronary artery from aneurysmal dilation of pulmonary trunk in a adolescent: involution after surgery occlusion of sinus venosus atrial septal defect and pulmonary trunk plasty for reduction

Relatamos o caso de um adolescente encaminhado com o diagnóstico de hipertensão pulmonar. A investigação não invasiva detectou comunicação interatrial seio venoso com sinais de hipertensão pulmonar. No estudo hemodinâmico o diagnóstico foi confirmado, sendo também notada compressão esquerda pelo tronco pulmonar. O paciente foi submetido à oclusão cirúrgica da comunicação interatrial e à plastia redutora do tronco pulmonar. Dois anos após o procedimento, o paciente encontra-se bem, com sinais clínicos e ecocardiográficos de hipertensão pulmonar discreta e sem evidências, também pelo ecocardiograma, de obstrução do tronco da artéria coronária esquerda.

We report the case of an adolescent referred with initial diagnosis of pulmonary hypertension. Non-invasive investigation disclosed a sinus venous atrial septal defect with pulmonary hypertension. The hemodynamic study confirmed diagnosis, and also showed extrinsic compression of left main coronary artery by pulmonary trunk. Surgical closure of the defect in addition to pulmonary trunk plasty were undertaken. Two years after the surgery the patient is well, with clinical signs of mild pulmonary hypertension, and showing no evidence - also on echocardiogram - of left coronary artery trunk obstruction.

Angiocardiography analysis of complex congenital heart diseases with congenital coronary artery anomalies / 重庆医科大学学报

Objective:Analysis of complex congenital heart disease of children and the incidence of coronary abnormalities to explore the21(4):453-457. diagnostic value of coronary angiography.Methods:Angiocardio graphy cardiac catheterization of 229 children in Heart Center of Children's Hospital Chongqing Medical University from January 2006 to June 2009,the results were retrospectively analyzed,including the types and proportion of congenital heart diseases,incidences of coronary artery abnormalities,incidences of abnormal coronary artery crossing right ventricular outflow tract and prognosis.Results:Altogether,27(11.8%)cases of children with Congenital Coronary Artery Anomalies were detected.Highest incidenc(e6.55%)is L-coronary artery,which occupy 55.56% of Coronary Artery Anomalies.16(6.99%) cases of abnormal coronary artery crossing the right ventricular outflow tract,which including 7 cases of TOF,3 cases of DORV,3 cases of PA/VSD,1 case of TGA,1 case of CAVC and 1 case of SV/TGA.1 patient died of angiocardiography among the 27 cases of complicating coronary artery malformation,accounting for 3.7%in the total number of the angiography of complex congenital heart disease complicating coronary artery malformation,accounting for 0.44%in the total number of complex congenital heart disease.3 cases died after surgery, accounting for 16.7% of surgery.Conclusion:The incidence of coronary artery abnormalities in complex congenital heart disease in children is higher than the normal population;coronary angiography is an important means of final diagnosis coronary artery congenital variation.