Congenital coronary anomalies of origin and distribution in adults: a coronary arteriographic study
S Harikrishnan1, Sonney P Jacob, Jaganmohan Tharakan
1Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala. drharikrishnan@hotmail.com
Insights
Coronary anomalies, such as separate origins of coronary arteries, occur in 0.46% of patients. Understanding these variations is crucial for preventing complications during cardiac procedures.
Area of Science:
- Cardiology
- Anatomical Studies
- Medical Imaging
Background:
- Coronary anomalies require recognition to prevent complications in coronary intervention and cardiac surgery.
- Accurate identification of coronary artery origins and distribution is essential for patient safety.
Purpose of the Study:
- To determine the pattern and incidence of coronary anomalies in origin and distribution.
- To analyze the prevalence of specific types of coronary artery anomalies.
Main Methods:
- Retrospective review of 7400 coronary angiograms.
- Exclusion of patients with congenital heart diseases, coronary artery fistulae, and separate conus artery origins.
- Analysis of identified coronary anomalies in 34 patients.
Main Results:
- Identified 34 cases (0.46%) of coronary anomalies among 7400 angiograms.
- Most common anomaly: separate origins of left anterior descending and left circumflex arteries (35.3%).
- Other frequent anomalies include right coronary artery originating from the left sinus (20.6%) and left circumflex from the right sinus (20%).
Conclusions:
- The incidence of primary coronary anomalies may be lower than previously reported.
- The observed pattern of coronary anomalies is consistent with earlier findings.
Background:
Coronary anomalies should be recognized to avoid problems during coronary intervention and cardiac surgery.
Methods And Results:
We retrospectively reviewed 7400 coronary angiograms to find out the pattern and incidence of coronary anomalies of origin and distribution. We excluded patients with congenital heart diseases, coronary artery fistulae and patients with separate origin of the conus artery. and found 34 cases (0.46%) (22 males), mean age 50.7 +/- 12 years with coronary anomalies. Six cases underwent angiography prior to valve replacement and the rest were part of the evaluation for atherosclerotic coronary artery disease. The most common anomaly was separate origins of the left anterior descending coronary artery and left circumflex coronary artery [n=12 (35.3%)]. The next most common anomalies were origins of the right coronary artery from the left coronary sinus [n=7 (20.6%)] and left circumflex artery from the right sinus [n=6 (20%)]. A single coronary artery was seen in 3 cases (8.8%) which included one case of postmyocardial infarction ventricular septal rupture with triple-vessel disease, and another with two small coronary fistulae. One case each of the following coronary anomalies was found: (i) double right coronary artery, (ii) left anterior descending coronary artery from the right coronary sinus, (iii) all three coronary arteries originating separately from the right sinus, and (iv) left main coronary artery from the right sinus. Of these 34 patients, 11 (32.4%) had significant atherosclerotic disease in the anomalous vessel.
Conclusions:
The incidence of primary coronary anomaly seems to be less than that in earlier reports, but the pattern of anomalies appears to be similar.
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