Primary congenital anomalies of the coronary arteries: a coronary: arteriographic study
Insights
Congenital coronary anomalies are rare in India, with most cases involving origin or distribution variations. Atherosclerotic coronary artery disease risk appears similar to the general population in these patients.
Area of Science:
- Cardiology
- Human Genetics
- Medical Imaging
Background:
- Geographic variations in congenital coronary anomalies (CCAs) are documented globally.
- Data on CCAs within the Indian population remains limited, necessitating further investigation.
Purpose of the Study:
- To determine the incidence and patterns of CCAs in an Indian adult cohort.
- To assess the association between CCAs and atherosclerotic coronary artery disease (CAD).
Main Methods:
- Retrospective analysis of diagnostic coronary arteriography data from 4,100 adult patients.
- Classification and detailed description of identified coronary artery anomalies.
Main Results:
- The incidence of CCAs was 0.95% (39 patients), with anomalies of origin/distribution being most common (89.74%).
- The right coronary artery was the most frequent anomalous vessel (48.74%).
- Atherosclerotic plaques were present in 33.33% of anomalous arteries, with no increased risk of CAD compared to the overall cohort (66.66%).
Conclusions:
- CCAs are infrequent in this Indian cohort, with specific patterns of origin and distribution.
- CCAs do not appear to confer an increased risk for developing atherosclerotic CAD in this subgroup.
- Early recognition of CCAs is crucial for guiding coronary interventions and cardiac surgery.
Abstract:
Geographic variations in the incidence of different congenital coronary anomalies are well known, but infrequently studied in the Indian population. Among 4,100 adult patients who underwent diagnostic coronary arteriography, 39 (0.95%) patients (34 males, 5 females) had one or more anomalous coronary arteries. Their mean age was 46.4 +/- 8.2 years (range, 26-68 years). Thirty-five (89.74%) had anomalies of origin and distribution, while the remaining four (10.25%) had coronary artery fistulae. Right coronary artery was the commonest anomalous vessel, involved in 19 (48.74%) patients. It was originating from the left sinus of Valsalva in 15 and from the non-facing aortic sinus in four patients. Anomalous left circumflex artery was the second commonest anomaly, seen in 14 (35.89%) patients. Anomalous left anterior descending artery and anomalous left coronary artery from pulmonary artery were seen in one patient each. Among patients with coronary fistulae, two had fistulae between the left anterior descending artery and the main pulmonary artery, one between the conal artery and the right atrium, while the fourth patient had fistulae from the right coronary as well as from the left anterior descending artery to the left atrium. Atherosclerotic plaques in the anomalous arteries were seen in only 13 (33.33%) patients, much less than the overall incidence of coronary artery disease in patients with congenital coronary anomalies in this series (66.66%). In four (10.25%) patients, only the anomalous vessels were involved in coronary artery disease. Thus, in a small subgroup there does not appear to be an increased risk for development of atherosclerotic coronary artery disease in anomalous coronary arteries. Recognition of coronary anomalies is important in patients undergoing coronary arteriography, coronary interventions and cardiac surgery. Variations in the frequency of primary congenital coronary anomalies may possibly have a genetic background.
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