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Anomalous coronary arteries: angiographic findings in 80 patients
O Topaz1, E J DeMarchena, E Perin
1Cardiac Catheterization Laboratories, Division of Cardiology, University of Miami School of Medicine, Florida.
Insights
Anomalous coronary arteries are rare in adults (0.61%), often linked with congenital heart defects. These anomalies do not increase coronary atherosclerosis risk but require careful angiographic recognition for cardiac procedures.
Area of Science:
- Cardiology
- Medical Imaging
- Genetics
Background:
- Congenital coronary anomalies are variations in coronary artery anatomy.
- Their prevalence and clinical significance, particularly in relation to congenital heart disease and atherosclerosis, require further elucidation.
Purpose of the Study:
- To determine the prevalence and characteristics of anomalous coronary arteries in adults undergoing coronary arteriography.
- To investigate the association of these anomalies with congenital heart abnormalities and coronary atherosclerosis.
- To assess the clinical impact and implications for surgical and interventional procedures.
Main Methods:
- Retrospective analysis of coronary arteriography data from 13,010 adult patients.
- Detailed characterization of anomalous coronary artery origins and courses.
- Assessment of concomitant congenital heart diseases and coronary atherosclerosis incidence.
Main Results:
- Anomalous coronary arteries were identified in 0.61% of patients (80/13,010).
- The right coronary artery was the most common anomaly (50%), followed by the circumflex artery (22%).
- Twenty-three percent of patients had concomitant congenital heart abnormalities; anomalous coronary arteries were not associated with increased coronary atherosclerosis.
Conclusions:
- Congenital coronary anomalies are associated with a high incidence of congenital heart diseases.
- Anomalous coronary arteries do not appear to increase the risk of developing coronary atherosclerosis.
- Angiographic identification of anomalous coronary arteries is crucial for patients undergoing cardiac interventions.
Abstract:
Among 13010 adults who underwent coronary arteriography, 80 (0.61%) patients had a total of 83 anomalous coronary arteries. Thirty-three (41%) of the patients were of Hispanic origin, while out of the entire population studied 30% were Hispanic. The right coronary artery was the most common anomalous vessel. It was identified in 50 (62%) patients, arising in 35 from the left aortic sinus, in 14 from the posterior sinus, and in 1 from the left coronary artery. An anomalous circumflex artery was recognized in 22 (27%) patients. Nine (11%) patients presented an anomalous left anterior descending artery, 1 patient an anomalous left main coronary artery, and another an anomalous septal perforator artery. Twenty-three (29%) patients had concomitant congenital heart abnormalities, most commonly. bicuspid aortic valve and mitral valve prolapse. In each of 5 patients with complex congenital heart disease the course of the anomalous vessel could have interfered with a surgical procedure. In 4 cases anomalous coronary arteries were associated with either anomalous systemic venous circulation or anomalous cardiac veins. In 5 (6%) patients only, the anomalous coronary artery was solely responsible for a clinical event. Coronary atherosclerosis of the anomalous arteries was found in 28% of the patients, while the overall incidence of the disease in this series was 65%. Thus, anomalous coronary arteries are associated with a high incidence of congenital heart diseases, but do not appear to be associated with an increased risk for development of coronary atherosclerosis. The angiographic recognition of these vessels is important in patients who undergo coronary angioplasty or cardiac surgery. Variations in the frequency of congenital coronary anomalies as reported herein may be attributed to a genetic background.