Coronary Anomalies: Understanding of Normal Coronary Artery Development for Insight in Treatment of Coronary Artery Disease.

Coronary artery anomalies (CAA) are rare congenital abnormalities with incidence of about 1% in the general population.2Unfortunately, despite the low incidence, CAA can cause sudden cardiac death. Identifying the course of the artery is critical for appropriate management. We present a rare case of the left coronary artery arising from the right coronary ostium with special emphasis on normal coronary artery development as possible insight for treatment of diseased heart.

previously undescribed complex coronary artery anomaly

Coronary artery anomalies are uncommon disorders. According to the literature, almost equal to 1% of the general population is affected by a coronary artery abnormality. Coronary artery anomalies are often not associated with clinical signs, symptoms, or complications; nevertheless, they can be associated with congenital heart diseases and lead to sudden death. However, these anomalies are more often discovered as incidental findings at the time of coronary angiography or autopsy. The clinical relevance of coronary artery anomalies is closely related to the functional ability to provide adequate blood supply to the myocardial tissue. We describe a complex left coronary artery anomaly, not previously reported in medical literature, involving origin, course, and distribution of this vessel

Nacimiento anómalo de las arterias coronarias en 10.000 pacientes adultos sometidos a coronariografía / Coronary artery origin anomalies. Analysis of 10.000 coronary angiographies

Background: Between 0.3 and 1.3 percent of coronary arteries, have anomalous origins. Circumflex artery has the higher frequency of anomalies. Aim: To study the frequency of congenital anomalous origins of coronary arteries among adult patients subjected to a coronary angiography. Material and Methods: Analysis of reports of 10,000 coronary angiographies performed in a clinical hospital. Patients with congenital heart disease were excluded. Results: One hundred twenty nine patients (1.3 percent), aged 59 ± 12years (70 percent males) had congenital anomalies in the origin of coronary arteries. The most common anomaly was the origin of right coronary artery from the left coronary sinus in 75 percent, followed from the origin of circumflex artery from the right side in 20 percento. No association between origin anomalies and atherosclerosis or aortic valve disease, was observed. Conclusions: In this series of patients, origin anomalies of coronary arteries were not associated with aortic valve disease or atherosclerosis, differing from other published reports. Right coronary artery had the highest frequency of anomalies.

Solitary coronary artery nourishing the entire heart

Coronary artery anomalies are being more frequently diagnosed these days both because increasing numbers of patients are undergoing diagnostic studies and because advanced radiographic imaging methods are now commonly available. An isolated single coronary artery giving rise to the main coronary branches is a rare congenital anomaly. In this report we present a patient with a solitary coronary ostium, with both the left and right coronary artery systems arising from it, and then following their usual courses. This case was diagnosed incidentally during conventional angiography

Coronary artery abnormalities in Puerto Rico

A retrospective study was done to determine the frequency of coronary artery anomalies in terms of their origin, course, and structure. The clinical history, catheterization data and surgical reports of patients undergoing coronary angiography at the Cardiovascular Center of Puerto Rico and the Caribbean, from 1999 to 2004, were analyzed. Thirty-eight patients were identified with a coronary artery anomaly in this population. These anomalies were classified according to their clinical consequences and the need for surgical intervention.

Coronary anomalies in Sudanese patients: angiographic study and brief review

Coronary anomalies are not rare [about 1'% of the general population] and may be associated with sudden dealth and ischemia and may cause difficulties in coronary interventions and errors in bypass surgery. The aim of this study is to demonstrate their incidence in the Sudanese patients and give a review on their classifications and clinical relevance- A retrospective study of 270 patients who had coronary angiography at Ahmed Gasim cardiac center from April, 2004 to August, 2005 Our study showed a rather higher rate of coronary anomalies [3%] but the pattern was not greatly different from the figures in the literature. Anomalies of origin were the most common [which may give difficulties in coronary interventions]. Potentially morbid anomaly with either the left anterior Ascending artery [LAD] or the left main coronary artery [LMCA] originating from the right coronary sinus was seen in 3 patients [1, 1%]. This study demonstrated that coronary anomalies are not rare in our patients and potentially serious anomaly may exist

Coronary artery ectasia: angiographic, clinical profile and follow-up.

Out of 3200 coronary angiograms we reviewed, there were 144 cases of coronary ectasia--an incidence of 4.5 percent. Among these, 122 were associated with atherosclerotic coronary artery disease, i.e. coronary stenosis more than 50 percent (group A) and 22 not associated with coronary artery disease (group B). The patients in groups A and B were compared with age- and sex-matched patients (group C) (n=100) who had coronary artery disease alone without ectasia. The incidence of ectasia was not increased in patients with thoracoabdominal aortic aneurysm i.e. 2/154 (1.8%) or in patients with peripheral occlusive vascular disease i.e. 5/161 (3.1%). Ectasia was typed according to a modified version of the criteria proposed by Markis et al. Type II was the commonest, followed by type I, III and IV. Right coronary artery was the most commonly involved vessel by ectasia followed by left circumflex, left anterior descending artery and left main coronary artery. Diffuse ectasia was seen more frequently in right coronary artery and localised ectasia in left anterior descending artery. Patients in groups A and B had similar epidemiological characteristics, though more patients with ectasia alone (group B) had better left ventricular function and negative stress tests. The patients in group A had a similar incidence of previous myocardial infarction, coronary risk factor profile, treadmill exercise test status and severity of coronary artery disease when compared to group C. On a mean follow-up of 3+/-1.2 years, all the three groups had similar event rates.

Incidence of myocardial bridges in northwest Indians.

Dissection of hearts obtained at autopsy from 150 adults (110 males, 40 females) and 15 children (10 males, 5 females) showed an incidence of myocardial bridges over the coronary arteries to be 34.5% in the male and 32.5% in female adults (p = NS); in children the incidence was 40% in either sex. A similar incidence was found in the neonates. Such bridges were also present in the fetuses. A bridge over the anterior interventricular artery could be identified as early as 60mm C.R. stage. An examination of serial sections of 3 early embryos indicated that the coronary arteries develop epimyocardially. The myocardial bridges seem to develop concurrently with the development of myocardium. In 63% instances a bridge was present on the anterior interventricular artery, other arteries were involved less frequently.

Myocardial bridge (MB): an angiographic curiosity?

The coronary angiograms of 1,500 cases performed between 1981 and 1989 were analysed to find out the incidence of Myocardial Bridge (MB) and its significance as regards myocardial ischemia. Sixteen of these (1.06%) were found to have MB. Their ages ranged from 27-70 years (m = 49.2) and male:female ratio was 13:3. Out of 16 patients, 7 (group A) had associated coronary artery disease (CAD) (7 of 1421; 0.49%) and remaining 9 (group B) had no associated CAD (9 of 79; 11.39%). All the MB were found on left anterior descending artery (LAD) (3 on proximal LAD and 13 on mid LAD). No MB was found on right coronary artery (RCA) or circumflex arteries. The location of the MB did not affect the pattern of CAD. Chronic stable angina was the commonest presenting symptom in group A patients (5 out of 7) and atypical angina in group B patients (5 out of 9). Majority of group B patients had either normal or nonspecific ST-T changes in ECG (7 out of 9). However, the presence of previous myocardial infarction or ECG evidence of 'Q' wave infarction (2 out of 2) was always associated with significant CAD. Similarly, regional wall motion abnormalities on echocardiogram were always found in patients with significant CAD and old myocardial infarction. All 9 patients with MB and normal coronary arteries were managed conservatively with good relief of symptoms, whereas other seven patients were managed on the merits of the underlying CAD. In conclusion, the MB is a normal variant found incidentally on coronary angiography, and does not have any definite clinical correlations or pathological significance.