Evaluation of Anomalous Coronary Arteries on 64 Slice Multidetector Computerized Tomographic Angiography
Introduction: Anomalous Coronary arteries is a well-known congenital entity with variable effects. The majority of such patients are asymptomatic but some can have adverse effects like ischemia and arrhythmia. Its association with Sudden Cardiac Death in young is established.
Objective: To determine the frequency of ACA on MDCT in patients referred for coronary artery disease assessment and to determine the origin, course, and morphological variable of SCD of ACA on MDCT.
Materials and Methods: The study was done in the Department of Cardiovascular Imaging at the Punjab Institute of Cardiology. A retrospective data of patients undergoing CTA for CAD between a period of Jan 2009 and Dec 2017 were analyzed for the presence of Anomalous Coronary Artery (ACA). All patients having anomalous origin from opposite coronary cusp and its course were included. The patients with myocardial bridging and coronary artery fistula were excluded.
Results: Total patients analyzed with MDCT for CAD and graft assessment between Jan 2009 and December 2017 were 8028. Fifty-three patients were excluded because of poor image quality. Among these ACA were found in 166 (2.08%). Gender distributions were 126 (75.9%) males and 40 (24.09%) females, the mean age in years was 49.31 ± 13.23. The most common ACA was Right coronary artery 83 followed by Left Circumflex 44 (26.50%), Left Anterior Descending Artery 22 (13.25%), and Left Main Stem 17 (10.24%) respectively. Fifty-three (31.92%) patients had previously unknown ACA and were found to have ACA on MDCT and 82 (49.39%) patients were referred following ICA for the confirmation of ACA. The Inter-arterial course was predominant in RCA and Left Coronary Artery 97% and 77% respectively. A retro artic course was predominant (100%) in LCx. Seven patients had associated cyanotic heart disease with ACA. Two patients(one LAD and one RCA) had origin from the Main Pulmonary artery.
Conclusion: MDCT is the imaging modality of choice for the evaluation of ACA. It can identify the origin of ACA from opposite coronary cusp and defines the malignant course of ACA for the potential risk of sudden cardiac death.
2 Montaudon M, Latrabe V, Iriart X, Caix P, Laurent F. Congenital coronary arteries anomalies: review of the literature and multidetector computed tomography (MDCT)-appearance. SurgRadiol Anat. 2007;29(5):343–55.
3 Dodd JD, Ferencik M, Liberthson RR, Cury RC, Hoffmann U, Brady TJ et al. . Congenital anomalies of coronary artery origin in adults: 64-MDCT appearance. Am J Roentgenol 2007;188:W138–46.
4 8. Angelini P. Coronary artery anomalies--current clinical issues: definitions, classification, incidence, clinical relevance, and treatment guidelines. Tex Heart Inst J. 2002;29:271–278.
5 9. Angelini P, Velasco JA, Flamm S. Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation. 2002;105:2449–2454.
6 Tuncer C, Batyraliev T, Yilmaz R, et al. Origin and distribution anomalies of the left anterior descending artery in 70,850 adult patients: multicenter data collection. Catheter Cardiovasc Interv 2006; 68: 574–585
7 Basso C, Maron BJ, Corrado D, et al. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2000; 35: 1493–1501.
8 Christoph Gräni, Ronny R. Buechel, Philipp A. Kaufmann, Raymond Y. KwongMultimodality Imaging in Individuals With Anomalous Coronary Arteries.J Am Coll CardiolImg. 2017 Apr, 10 (4) 471-481.
9 Lorenz EC, Mookadam F, Mookadam M, et al. A systematic overview of anomalous coronary anatomy and an examination of the association with sudden cardiac death. Rev Cardiovasc Med 2006;7:205–13
10 Cohen MS, Herlong RJ, Silverman NH. Echocardiographic imaging of anomalous origin of the coronary arteries. Cardiol Young 2010;20(Suppl 3):26-34.
11 Frommelt P.C., Berger S., Pelech A.N., Bergstrom S., Williamson J.G. (2001) Prospective identification of anomalous origin of left coronary artery from the right sinus of valsalva using transthoracic echocardiography: importance of color Doppler flow mapping. PediatrCardiol 22:327–332
12 Kim SY, Seo JB, Do KH, et al. Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation. Radiographics. 2006;26(2):317-334.
13 Miller JA, Anavekar NS, El Yaman MM, Burkhart HM, Miller AJ, Julsrud PR. Computed tomographic angiography identification of intramural segments in anomalous coronary arteries with interarterial course. Int J Cardiovasc Imaging. 2012;28(6):1525-1532. doi:10.1007/s10554-011-9936-9
14 Finocchiaro.G, ElijahR. Behr, Gaia Tanzarella, Michael Papadakis, Aneil Malhotra, Harshil Dhutia, Chris Miles, Igor Diemberger, Sanjay Sharma, MaryN. Sheppard.Anomalous Coronary Artery Origin and Sudden Cardiac Death.J Am Coll Cardiol EP. 2019 Apr, 5 (4) 516-522
15 Maron B.J., Doerer J.J., Haas T.S., Tierney D.M., Mueller F.O. (2009) Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006. Circulation 119:1085–1092
16 Christoph Gräni, Philipp A Kaufmann, Stephan Windecker, Ronny R Buechel.Diagnosis and Management of Anomalous Coronary Arteries with a Malignant CourseInterventional Cardiology Review 2019;14(2):83–8.
17 Maron BJ, Haas TS, Ahluwalia A, et al. Demographics and epidemiology of sudden deaths in young competitive athletes: from the United States National Registry. Am J Med 2016;129:1170–7.
18 Quah JX, Hofmeyr L, Haqqani H, et al. The management of the older adult patient with anomalous left coronary artery from the pulmonary artery syndrome: a presentation of two cases and review of the literature. Congenit Heart Dis. 2014;9(6):E185-E194.
19 Yau J., Singh R., Halpern E., Fischman D. Anomalous origin of the left coronary artery from the pulmonary artery in adults: a comprehensive review of 151 adult cases and a new diagnosis in a 53-year-old woman. ClinCardiol. 2011;34(4):204–210
Copyright (c) 2020 Tahir Naveed, Imran Saeed Ali, Syed Moazzam Ali Naqvi, Bilal S Mohydin, Muhammad Ayub
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
All research articles published in the Journal of Rawalpindi Medical College (JRMC) are fully open access: immediately freely available to read, download, and share. Copyrights of all articles published in JRMC are retained by the authors. First publication rights are granted to JRMC. The journal/publisher is not responsible for subsequent uses of the work.
All articles are published under the Creative Commons Attribution (CC BY-SA 4.0) license.