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Anomalous aortic origin of a coronary artery in 16,680 patients evaluated by cardiac computed tomography

Alexander Suchodolski1, Aleksandra Korus2, Dariusz Kucias2

  • 1Department of Cardiology and Electrotherapy, Silesian Center for Heart Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.

Polish Journal of Radiology
|May 21, 2026
PubMed

Insights

Anomalous aortic origin of a coronary artery (AAOCA) occurs in 0.58% of cardiac CT scans. The right anomalous origin of the left circumflex artery (R-LCx) is most common, with most cases showing benign clinical manifestations.

Area of Science:

  • Cardiology
  • Radiology
  • Congenital Heart Disease

Background:

  • Anomalous aortic origin of a coronary artery (AAOCA) is a congenital anomaly where a coronary artery arises abnormally from the aorta.
  • Classification systems, such as Cheezum et al., categorize AAOCA based on origin and course.
  • Understanding the frequency and types of AAOCA is crucial for assessing risks, including sudden cardiac death.

Purpose of the Study:

  • To determine the frequency of AAOCA in adult patients undergoing cardiac CT.
  • To identify the most common types and courses of AAOCA.
  • To evaluate the clinical manifestations and potential risks associated with different AAOCA types.

Main Methods:

  • Retrospective analysis of 16,680 electrocardiography-gated cardiac CT scans from 2015-2022.
  • Inclusion criteria: identifiable coronary anomalies on CT, age over 18.
  • Final sample comprised 96 patients with diagnosed AAOCA.

Main Results:

  • AAOCA was identified in 0.58% of all scans.
  • The most frequent anomaly was the right anomalous origin of the left circumflex artery (R-LCx) (50%).
  • The most common course was retroaortic (48%), followed by interarterial (29%).

Conclusions:

  • AAOCA is a rare finding, present in less than 1% of cardiac CT scans.
  • R-LCx with a retroaortic course represents the most prevalent AAOCA.
  • Most identified AAOCAs exhibited benign clinical presentations.
Abstract

Keywords:
X-ray computed tomographycardiac-gated imaging techniquescoronary vessel anomalies

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