Congenital coronary artery anomalies angiographic classification revisited

Many fragmental classification of coronary artery anomalies (CAAs) exist, but a simple practical angiographic classification for angiographers has been never proposed. This study is aimed to suggest a simplified angiographic classification of congenital CAAs based on just a few univocal common angiographic patterns. The authors reviewed 5100 coronary angiographies in order to select CAAs patients and identify simple common angiographic features. Sixty-two patients (1.21%, female/male 20/42, mean age 65.3 +/- 10.6 years) had CAA on coronary angiography. The authors identified seven classes for seven angiographic patterns: I--hypoplasia/atresia, II--hyperdominance, III--fistula, IV--originating from wrong sinus, V--originating from other arteries, VI--splitting, and VII--tunnelling. A, P, B, R, L, PA, AO refer to anterior, posterior or passage between the aorta and pulmonary artery and to right, left, pulmonary artery and aorta. Three blind observers were be able to categorize all the CAAs according to this classification with no inter-observer differences: 3.2% were classified as class I, 8.1% as class II, 3.2% as class III, 24.2% as class IV, 22.5% as class V, 29% as class VI, and finally 9.7% as class VII. Eleven patients (17.7%) had 'A' passage, 10 (16.1%) 'P' passage and 9 (14.5%) 'B' passage. Twelve patients (19.5%) had anomalous origin from the right sinus of Valsalva, 2 (3.2%) from the left. This simplified classification was applicable to all most significant CAAs and in the authors' view it may make for a more rapid and univocal CAA angiographic description.