Coronary anomalies: what the radiologist should know

Abstract

Coronary anomalies comprise a diverse group of malformations, some of them asymptomatic with a benign course, and the others related to symptoms as chest pain and sudden death. Such anomalies may be classified as follows: 1) anomalies of origination and course; 2) anomalies of intrinsic coronary arterial anatomy; 3) anomalies of coronary termination. The origin and the proximal course of anomalous coronary arteries are the main prognostic factors, and interarterial course or a coronary artery is considered to be malignant due its association with increased risk of sudden death. Coronary computed tomography angiography has become the reference method for such an assessment as it detects not only anomalies in origination of these arteries, but also its course in relation to other mediastinal structures, which plays a relevant role in the definition of the therapeutic management. Finally, it is essential for radiologists to recognize and characterize such anomalies.

CT coronary angiography findings in non-atherosclerotic coronary artery diseases

“…Coronary anomalies comprise a variety of malformations, some of them are benign course with no symptom, and the others related to symptoms such as chest pain or sudden death. Such anomalies may be classified as follows: 1) anomalies of 32 origin and course; 2) anomalies of intrinsic coronary anatomy; 3) congenital 33 fistulas 3 . CCTA is regarded as the first choice for the initial screening of 34 congenital coronary anomalies as it enables excellent visualization of the course of the coronary arteries.…”

Paciente idosa portadora de doença aterosclerótica submetida à cineangiocoronariografia com achado incidental de origem e curso anômalos de artéria coronária esquerda: relato de caso

“…A artéria coronária esquerda normalmente sai do seio coronariano esquerdo e após uma distância de aproximadamente quatro (04cm) bifurca-se em artéria circunflexa esquerda e descendente anterior; já a artéria coronária direita sai do seio coronariano direito e segue um trajeto posterior a artéria pulmonar, perto ao apêndice atrial direito, ao longo do sulco atrioventricular 6,7 . A artéria coronária direita irriga a parede do ventrículo direito; a artéria descendente anterior irriga a parede anterior e o septo interventricular; já a artéria circunflexa irriga a parede do ventrículo esquerdo 8 .…”

“…Existe uma outra classificação, que divide as anomalias coronarianas em hemodinamicamente significativas e não significativas. As anomalias coronarianas hemodinamicamente significativas englobam: as anomalias de origem com trajeto interarterial; com origem anômala na artéria pulmonar; as atresias e as fístulas congênitas 8 .…”

Most common anatomic anomalies of coronary arteries

“…Hemodynamically, unstable anomalies comprise anomalies of origin with intra-arterial course; and those with anomalous origin, from the pulmonary artery, atresias, and congenital fistulas. 7 CA can also be classified as benign or malignant, according to the likelihood of eliciting coronary disease, and, additionally coursing asymptomatically throughout several years, progressing to a sudden event during stress, massive physical effort, or even without a clear cause. As a consequence, CA are considered the second major cause of sudden death in young athletes and can also be associated with acute myocardial infarction (MI) and/or arrhythmia in this specific population.…”