Transseptal coronary artery-a pictorial review

Area of Science:

• Cardiology
• Radiology
• Anatomical Pathology

Background:

• A transseptal coronary artery course, or transconal course, involves the left main coronary artery (LMCA) or left anterior descending artery (LAD) traversing the conal septal myocardium.
• This myocardial wall separates the subaortic and subpulmonary outflow tracts within the right ventricular outflow tract (RVOT).
• While often considered benign, this anomaly can lead to myocardial ischemia, arrhythmia, and sudden cardiac death due to systolic compression.

Purpose of the Study:

• To describe the imaging characteristics of transseptal coronary artery course using coronary computed tomography angiography (CTA).
• To discuss the clinical significance and analysis of these anomalous coronary artery findings.
• To provide a brief overview of the management strategies for transseptal coronary artery lesions.

Main Methods:

• Review of coronary computed tomography angiography (CTA) scans to identify and characterize transseptal coronary artery courses.
• Analysis of associated clinical data and patient symptoms.
• Literature review for management strategies.

Main Results:

• Detailed description of the anatomical course and imaging findings of transseptal coronary arteries on CTA.
• Correlation of imaging findings with potential clinical manifestations such as ischemia and arrhythmia.
• Identification of systolic phase compression as a potential mechanism for symptoms.

Conclusions:

• Transseptal coronary artery course, though rare, requires careful evaluation due to potential for significant cardiac events.
• Coronary CTA is crucial for diagnosing and characterizing this anomaly.
• Appropriate clinical analysis and management are essential for patients with symptomatic transseptal coronary artery course.