Anomalous origin of coronary arteries with an interarterial course: pictorial essay
Ana Flávia Pina Ferreira1, Sharon Rosemberg1, Daniel Simões Oliveira1
1Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil.
Insights
Anomalous coronary arteries originating from the wrong sinus and running between the aorta and pulmonary artery can be fatal. Computed tomography angiography aids in diagnosing these potentially life-threatening coronary artery anomalies.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Anatomical Variations
Background:
- Anomalous coronary artery origin from the contralateral sinus with an interarterial course is a rare but potentially fatal condition.
- This anomaly necessitates accurate diagnosis for appropriate management and risk stratification.
Purpose of the Study:
- To illustrate potentially fatal coronary artery anomalies with an interarterial course.
- To aid radiologists in recognizing and describing these anomalies using computed tomography (CT) angiography.
Main Methods:
- Review of computed tomography (CT) angiography images of the chest and aorta.
- Identification and characterization of coronary arteries originating from the contralateral sinus with an interarterial course.
Main Results:
- The right coronary artery originating from the left sinus is the most common variant, often with a better prognosis.
- Left coronary artery originating from the right sinus carries a high risk of sudden death, mandating surgical intervention.
- Interarterial course classification (high/low) impacts risk stratification and treatment decisions.
Conclusions:
- Computed tomography (CT) angiography is crucial for visualizing the entire course of anomalous coronary arteries and associated atherosclerosis.
- Accurate identification of these anomalies by radiologists is essential for timely therapeutic planning and preventing adverse outcomes.
Abstract:
Coronary arteries originating from the contralateral (noncoronary) sinus and having an interarterial course, in which they run from the ascending aorta to the pulmonary trunk, is a potentially fatal anomaly. Computed tomography (CT) angiography facilitates the recognition and therapeutic planning of such anomalies because of its ability to acquire high-resolution images of the entire course of the coronary artery, as well as of the accompanying atherosclerotic involvement. The right coronary artery originating from the left coronary sinus is the most prevalent anomaly of this type and usually implies a better prognosis, the interarterial course being classified as "high" or "low", depending on whether it is above or below the level of the pulmonary valve, with consequent stratification of the risk and the treatment. However, it is known that there is a high risk of sudden death among patients with a left coronary artery of anomalous origin from the right sinus. In such cases, surgical treatment is recommended, regardless of whether there are symptoms or evidence of ischemia. Given the importance of those aspects, which can be identified on CT of the chest or CT angiography of the aorta, this pictorial essay aims to illustrate such anomalies to facilitate their recognition and description by radiologists who are not specialists in cardiac imaging.
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