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Coronary artery anomalies in 126,595 patients undergoing coronary arteriography
1Department of Cardiology, Cleveland Clinic Foundation, OH 44195.
Insights
Coronary artery anomalies occur in 1.3% of patients. Most are benign and found incidentally, but some serious anomalies require recognition and potential surgical correction.
Area of Science:
- Cardiology
- Congenital Heart Disease
Background:
- Coronary artery anomalies are variations in the anatomy of the heart's major blood vessels.
- These anomalies can range from incidental findings to conditions with significant clinical implications.
Purpose of the Study:
- To analyze the incidence, types, and clinical significance of coronary artery anomalies.
- To differentiate between benign and potentially serious coronary artery anomalies.
Main Methods:
- Retrospective review of coronary arteriography data from 1,686 patients.
- Classification of anomalies based on origin, distribution, and presence of fistulae.
Main Results:
- An incidence of 1.3% for coronary artery anomalies was observed.
- 87% involved origin and distribution; 13% were coronary artery fistulae.
- 81% of anomalies were benign, often found incidentally.
Conclusions:
- Coronary artery anomalies are relatively uncommon but diverse.
- Accurate diagnosis is crucial as some anomalies carry risks of serious cardiac events.
- Surgical intervention may be necessary for specific high-risk coronary anomalies.
Abstract:
Coronary artery anomalies were found in 1,686 patients (1.3% incidence) undergoing coronary arteriography at the Cleveland Clinic Foundation from 1960 to 1988. Of the 1,686 patients, 1,461 (87%) had anomalies of origin and distribution, and 225 (13%) had coronary artery fistulae. Most coronary anomalies did not result in signs, symptoms, or complications, and usually were discovered as incidental findings at the time of catheterization. Eighty-one percent were "benign" anomalies: 1) separate origin of the left anterior descending and circumflex from the left sinus of Valsalva; 2) ectopic origin of the circumflex from the right sinus of Valsalva; 3) ectopic coronary origin from the posterior sinus of Valsalva; 4) anomalous coronary origin from the ascending aorta; 5) absent circumflex; 6) intercoronary communications; and 7) small coronary artery fistulae. Other anomalies may be associated with potentially serious sequelae such as angina pectoris, myocardial infarction, syncope, cardiac arrhythmias, congestive heart failure, or sudden death. Potentially serious anomalies include: 1) ectopic coronary origin from the pulmonary artery; 2) ectopic coronary origin from the opposite aortic sinus; 3) single coronary artery; and 4) large coronary fistulae. Coronary artery anomalies require accurate recognition, and at times, surgical correction.