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[Congenital anomalies of coronary artery origin: a diagnostic challenge]
A Iñiguez Romo1, C Macaya Miquel, F Alfonso Monterola
1Servicio de Exploración Cardiopulmonar, Hospital Universitario San Carlos, Madrid.
Insights
Congenital anomalous origin of coronary arteries is rare (0.37%) but can cause severe coronary stenosis. The left circumflex coronary artery was most frequently affected, often with a retro-aortic course.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Interventional Cardiology
Background:
- Congenital anomalous origin of coronary arteries (CAOC) is a rare condition.
- It can be associated with significant coronary artery disease.
- Understanding its prevalence and characteristics is crucial for diagnosis and management.
Purpose of the Study:
- To determine the prevalence of CAOC in patients undergoing diagnostic coronary angiography.
- To describe the clinical characteristics, anatomical variations, and angiographic findings of patients with CAOC.
- To assess the association between CAOC and coronary artery lesions.
Main Methods:
- Retrospective analysis of 4,313 consecutive patients undergoing diagnostic coronary angiography.
- Identification and classification of patients with CAOC.
- Review of patient demographics, clinical presentation, and angiographic findings.
Main Results:
- 16 patients (0.37%) had CAOC, with no other congenital cardiac anomalies.
- The most common anomaly was anomalous origin of the left circumflex coronary artery (50%).
- Severe coronary stenosis was present in 75% of patients, with lesions in the anomalous vessel in 5 cases.
Conclusions:
- CAOC is an uncommon finding in diagnostic coronary angiography.
- Patients with CAOC frequently have associated coronary artery stenosis, often requiring specialized techniques for visualization.
- Anomalous origin of the left circumflex coronary artery is the most prevalent type.
Abstract:
From a series of 4,313 consecutive patients who underwent a diagnostic coronary angiogram, 16 (0.37%) presented a congenital anomalous origin of the coronary arteries. None of these patients had other congenital cardiac anomalies associated. Age was 57 +/- 9 years and 13 (81%) were male. The diagnostic catheterization was performed for unstable angina in 8 patients (50%), for stable angina in five (32%), for dyspnea in two and for atypical chest pain in the remaining patient. A previous myocardial infarction was present in 6 patients (37%) whereas one patient had apical hypertrophic cardiomyopathy. We observed absence of coronary lesions in 4 patients and severe coronary stenosis lesions in 12 patients (75%), five of those with lesions located in the anomalous vessel. The most frequent abnormality found was an anomalous origin of left circumflex coronary artery in 8 cases (50%), followed by an abnormal origin of the right coronary artery in 5 cases (31%), and an abnormal origin of the left coronary tree in 3 cases (19%) (left anterior descending coronary artery arising from the right coronary artery, a single coronary artery which originated in the left coronary sinus, and a left main coronary artery which originated in the noncoronary sinus). The relationship of the anomalous coronary artery to the great vessels was the following: A retro-aortic course in 11 patient (69%), by the anterior free wall in two (12.5%), interarterial in two (12.5%), and septal in one (6%). Finally, as an index of the difficulty to visualize the anomalous coronary artery, an unusual catheter was needed in six (37%) of the diagnostic procedures to reach the target vessel.(ABSTRACT TRUNCATED AT 250 WORDS)