Coronary anomalies: what the radiologist should know

Area of Science:

• Cardiovascular Imaging
• Radiology
• Congenital Heart Disease

Background:

• Coronary anomalies are diverse malformations with varied clinical outcomes.
• Some anomalies present asymptomatically, while others are linked to severe symptoms like chest pain and sudden cardiac death.
• Classification includes anomalies of origin/course, intrinsic anatomy, and termination.

Purpose of the Study:

• To highlight the significance of coronary anomalies.
• To emphasize the prognostic importance of the origin and proximal course of anomalous coronary arteries, particularly the malignant interarterial course.
• To underscore the role of coronary computed tomography angiography in assessing these anomalies.

Main Methods:

• Coronary computed tomography angiography (CCTA) is utilized as the reference standard.
• CCTA assesses anomalies in artery origination and their course relative to mediastinal structures.
• Radiological recognition and characterization of coronary anomalies are crucial.

Main Results:

• The origin and proximal course of anomalous coronary arteries are critical prognostic indicators.
• An interarterial course is associated with an increased risk of sudden death, classifying it as malignant.
• CCTA effectively detects anomalies and their spatial relationship to other structures.

Conclusions:

• Accurate diagnosis and characterization of coronary anomalies are essential for patient management.
• Coronary computed tomography angiography is the preferred imaging modality for evaluating coronary artery anomalies.
• Understanding the course of anomalous arteries is vital for therapeutic decision-making and risk stratification.