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Published on: August 28, 2018
Remarkable anatomic anomalies of coronary arteries and their clinical importance: a multidetector computed tomography
Cihan Duran1, Mecit Kantarci, Irmak Durur Subasi
1Department of Radiology, Florence Nightingale Hospital, Istanbul, Turkey.
Insights
Anomalous coronary artery origins, including rare variations, occur in 5.79% of patients. Multidetector computed tomography (MDCT) is crucial for detecting these potentially life-threatening conditions.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Anatomical Variations
Background:
- Anomalous coronary artery origin and course present a spectrum from benign to life-threatening conditions.
- Advances in computed tomography technology have improved the detection and interpretation of coronary artery diseases.
- Radiologists play a key role in identifying these anatomical variations.
Purpose of the Study:
- To demonstrate significant coronary artery anomalies, some previously undetected by multidetector computed tomography (MDCT) coronary angiography.
- To discuss the clinical significance and implications of these coronary artery anomalies.
Main Methods:
- A study of 725 patients undergoing MDCT coronary angiography at two hospitals.
- Patient demographics included ages 33-78 years, with 68.6% males and 31.4% females.
- All MDCT examinations were jointly interpreted by a radiologist and a cardiologist.
Main Results:
- The incidence of anomalous coronary artery anatomy was 5.79% (42 patients).
- Specific anomalies included absence of the right coronary artery (RCA), ectopic origins of RCA and left main coronary artery, double left anterior descending (LAD) artery, and myocardial bridging (4%).
- Detailed incidence rates for each anomaly were provided.
Conclusions:
- Anomalous coronary artery origins require careful interpretation due to their clinical importance for patient management.
- MDCT, particularly with volume rendering and maximum intensity projection techniques, is effective for assessing complex coronary variations.
- MDCT can be superior to conventional angiography in visualizing certain complex coronary anomalies.
Objective:
An anomalous origin and course of the coronary arteries can be benign or life threatening. Recently, because of new advances in computed tomography technology, radiologists have begun to interpret the diseases of coronary arteries. We aimed to demonstrate some remarkable anomalies of coronary arteries, some of which were not shown by multidetector computed tomography (MDCT) coronary angiography previously, and to discuss the clinical importance of these anomalies.
Materials And Methods:
Seven hundred twenty-five consequent patients referred to Florence Nightingale Hospital and Atatürk University Hospital for MDCT coronary angiography were included in this study. The patients were between the ages of 33 and 78 years (mean +/- SD, 59 +/- 13.86 years). Four hundred ninety-seven patients (68.6%) were men, and 228 (31.4%) were women. All the examinations were evaluated by both a radiologist and a cardiologist.
Results:
The incidence of anomalous anatomical origin and course of the coronaries found in our study group was 5.79% (n = 42). The anomalies found in our study are absence of the right coronary artery (RCA; n = 1, 0.13%), ectopic origin of RCA from the left anterior descending (LAD) artery (n = 1, 0.13%), absence of the left main coronary artery (n = 4, 0.52%), ectopic origin of the left main coronary artery from the right sinus of Valsalva (n = 1, 0.13%), double LAD and ectopic origin of LAD from RCA (n = 1, 0.13%), ectopic origin of the left circumflex artery from the right sinus of Valsalva (n = 3, 0.39%), ectopic origin of the left circumflex artery from RCA (n = 2, 0.26%), and myocardial bridging (n = 29, 4%).
Conclusions:
An anomalous origin of the coronary anatomy must be present in the interpretations because of its importance for patients, cardiologists, and surgeons. As a conclusion, our study showed that MDCT, especially volume rendering and maximum intensity projection techniques, may be useful for assessment of complex variations, when the conventional angiography may not be sufficient.
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