Anomalous interarterial left coronary artery: an evidence based systematic overview

Area of Science:

• Cardiology
• Congenital Heart Disease
• Medical Diagnostics

Background:

• Isolated anomalous left main coronary artery (ALMCA) originating from the right aortic sinus of Valsalva (RASV) is a rare congenital heart abnormality.
• This anomaly is characterized by an interarterial course between the pulmonary trunk and aorta.

Purpose of the Study:

• To conduct a systematic overview of evidence spanning four decades.
• To assess the prevalence, clinical features, and management of ALMCA from RASV.

Main Methods:

• A comprehensive computerized literature search was performed over 40 years.
• Bibliographies of identified relevant articles were also meticulously searched.

Main Results:

• A total of 264 cases were identified, with ages ranging from 3.5 months to 87 years.
• Nearly half of the cases (49%) were diagnosed postmortem; sudden cardiac death was the presentation in over a third.
• Cardiac catheterization was the primary diagnostic tool (41.7%), followed by non-invasive imaging like echocardiography, MRI, and CT scans. Surgical intervention was performed in 21.6% of cases with no mortality.

Conclusions:

• ALMCA from RASV is linked to an elevated risk of sudden death, particularly in younger individuals.
• Despite advances in non-invasive diagnostics (echocardiography, CT, MRI), many cases are still diagnosed postmortem.
• Surgical correction is the definitive treatment, demonstrating low risk and achieving favorable anatomical and functional results.