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Coronary artery anomalies in adult patients
Mehmet Kamil Göl1, Mehmet Ali Ozatik, Aysegül Kunt
1Cardiovascular Surgery Clinic, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey. nkgol@ada.net.tr
Insights
Coronary artery anomalies are uncommon, found in 0.44% of angiograms. Awareness is crucial for clinicians managing these incidental findings, especially the circumflex artery variations.
Area of Science:
- Cardiology
- Radiology
- Cardiac Surgery
Background:
- Coronary artery anomalies are rare, identified in less than 1% of coronary angiograms.
- Increasing rates of angiography and bypass surgeries highlight their clinical significance.
Purpose of the Study:
- To analyze the incidence and characteristics of coronary artery anomalies.
- To emphasize the importance of recognizing these anomalies in clinical practice.
Main Methods:
- Retrospective analysis of 58,023 coronary angiographies performed between 1978 and 2001.
- Identification and classification of coronary artery anomalies in 257 patients (0.44%).
Main Results:
- The circumflex artery (CXA) was the most frequently anomalous vessel (51.1%).
- Coronary artery fistulae were observed in 54 patients, with 33.3% requiring surgical closure and a 5.5% perioperative mortality.
- 76 patients needed open heart surgery, including 57 for coronary artery bypass grafts.
Conclusions:
- Coronary artery anomalies are often asymptomatic and incidentally discovered in adults.
- These anatomical variations necessitate awareness among interventional cardiologists, radiologists, and cardiac surgeons.
- Left main coronary artery (LMCA) originating from the right coronary system requires close monitoring due to risks of sudden death and myocardial ischemia.
Background:
Coronary artery anomalies are discovered in less than 1% of angiography series. Since the number of angiographies and coronary bypass operations are increasing significantly every day, these anomalies are of clinical importance.
Material/Methods:
58,023 coronary angiographies were performed in the cardiology clinic of our hospital from 1978 to 2001. Coronary artery anomalies were discovered in 257 of these cases (0.44%). The mean age of these patients was 51.9+/-11.4 years (18-82). 80% were male (n=207).
Results:
The circumflex artery (CXA) was the most frequently involved vessel (51.1%). Coronary arteries originating from the pulmonary artery were not encountered in our series due to the natural history of the disease. In 54 patients with coronary artery fistulae, 18 (33.3%) were closed by operation. Perioperative mortality was 5.5%. Acquired coronary artery fistulae or aneurysms due to trauma or inflammatory diseases are completely different entities and beyond the scope of this article. In 76 patients, open heart surgery was required for additional lesions, 57 of which were coronary artery bypass grafts.
Conclusions:
Being usually asymptomatic, coronary artery anomalies are usually discovered incidentally in the adult population. These pathologies are important for practical purposes, especially for interventional cardiologists, radiologists and cardiac surgeons, who should be aware of these anatomical entities. LMCA originating from the right coronary system has been reported to result in sudden death and myocardial ischemia, so these mostly asymptomatic patients must be followed closely.