Anomalous right coronary artery originated from left coronary sinus with interarterial course: evaluation of the
Bae Young Lee1, Kyung Sup Song, Seung Eun Jung
1Department of Radiology, St Paul's Hospital, College of Medicine, The Catholic University of Korea, 620-56 Jeonnong-dong, Dongdaemun-gu, Seoul 130-709, South Korea.
Insights
Anomalous origin of the right coronary artery (RCA) from the left sinus with an interarterial course is often benign. Takeoff angles correlate with narrowing, but most cases lack significant stenosis, suggesting a favorable prognosis.
Area of Science:
- Cardiology
- Radiology
- Anatomical Variations
Background:
- Anomalous origin of the right coronary artery (RCA) from the left coronary sinus with an interarterial course is a rare congenital anomaly.
- The clinical significance of this anomaly can be influenced by the location of its orifice and its course between the aorta and pulmonary artery.
Purpose of the Study:
- To evaluate the anatomical features of anomalous RCA using multidetector row computed tomography (MDCT).
- To correlate MDCT findings with clinical presentation and assess the potential for life-threatening complications.
Main Methods:
- Retrospective review of 25 MDCT scans from 24 patients with anomalous RCA.
- Analysis of orifice location, takeoff angle, and luminal diameters (orifice, interarterial, reference) using MDCT.
- Clinical correlation of MDCT findings.
Main Results:
- MDCT effectively visualized the anomalous RCA's orifice and interarterial course.
- Narrowing was more frequent at the orifice (16/25 cases) than the interarterial course (6/25 cases).
- Takeoff angles correlated with relative narrowing at the orifice (P=0.001) and interarterial course (P=0.007); only one patient had >50% stenosis.
Conclusions:
- Takeoff angles of anomalous RCA are associated with luminal narrowing at the orifice and interarterial course.
- The majority of anomalous RCA cases with an interarterial course exhibit a benign clinical course.
- Detailed evaluation of the proximal anomalous RCA anatomy is crucial for treatment planning.
Purpose:
Anomalous origin of the right coronary artery (RCA) with an interarterial course is a potentially life-threatening anomaly. Clinical significance could depend on its orifice and interarterial course. We evaluated the anomalous RCA on multidetector row computed tomography (MDCT) with clinical correlation.
Materials And Methods:
Twenty-five electrocardiography-gated MDCT cases of 24 patients (mean [SD] age, 58.2 [12.3] years; 12 men and 12 women) with anomalous origin of RCA from left coronary sinus with an interarterial course were retrospectively reviewed in 3 hospitals. The cases were evaluated for the location of orifice, a takeoff angle from coronary sinus, mean diameters of RCA (orifice, interarterial, and reference), and the ratio of the diameters of RCA (orifice-reference and interarterial-reference) on MDCT with clinical correlation.
Results:
The orifice and the interarterial course of all anomalous RCAs were well visualized on MDCT. The narrowest portion of RCA was more frequent in the orifice (16/25 cases) than the interarterial course (6 cases). Three cases revealed the same diameter between the orifice and the interarterial course. The location of the orifice was not correlated with the diameters of anomalous RCA. Takeoff angles were correlated with the relative narrowing of the orifice of anomalous RCA (P = 0.001) and the relative narrowing of the interarterial course (P = 0.007). Only 1 patient showed significant luminal narrowing (>50% stenosis), and this patient showed a minimal takeoff angle and a persistent symptom. The symptom of this patient had disappeared after operation, and postoperative MDCT revealed an increased takeoff angle and no significant luminal narrowing. The other patients showed no significant luminal narrowing. Symptoms were not correlated with the takeoff angle and relative luminal narrowing (orifice-reference and interarterial-reference; P = 0.923, P = 0.915, and P = 0.703).
Conclusions:
The takeoff angles of anomalous RCA with an interarterial course are correlated with the relative narrowing of luminal diameters at the orifice and the interarterial course. Most cases show a benign nature. Evaluation of the proximal structure of anomalous RCA with an interarterial course could be important in a treatment plan.
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