Anomalous Coronary Arteries in Adults: Depiction at Multi–Detector Row CT Angiography

Datta, Jaydip; White, Charles S.; Gilkeson, Robert C.; Meyer, Cristopher A.; Kansal, Sarita; Jani, Manish; Arildsen, Ronald C.; Read, Katrina

doi:10.1148/radiol.2353040314

Cited by 211 publications

(131 citation statements)

References 20 publications

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“…The associated symptoms are infrequent (generally about 80% of patients with coronary anomalies are asymptomatic) [2], therefore, as in our case, it's often an incidental finding. When the symptoms are present, they are extremely variable and nonspecific for a coronary anomaly hypothesis, including chest pain, dyspnea, arrhythmias, until clearer and more important symptoms as syncope, myocardial infarction or sudden death.…”

Section: When the Coronary Anomaly Saves Your Life: A Very Rare Ischesupporting

confidence: 49%

“…Coronary artery anomalies are rare and in literature the reported prevalence is about 0.6% to 1.3% [1] in angiographic diagnostic procedure and 0.3% in autopsy series, because many anomalies don't give symptoms during the patient's life (only 20% of patients have symptoms during their life) [2] and their reply is an incidental finding, especially when LMCA is involved, as in our case report, and a very rare anomalous origin of the Circumflex Artery(LCX) from Right Coronary Artery (RCA) plays an important role.…”

Section: -7721; E-mail: Pirainod@liberoitmentioning

confidence: 99%

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When the Coronary Anomaly Saves Your Life: a Very Rare Ischemic Coronary Presentation - Our Cardiac Catheterization Laboratory Experience and New Way of Treatment

Piraino¹

2015

JCTCD

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Left main coronary artery acute occlusion is a dramatic event, with a higher risk of sudden death, due to hemodynamic instability or malignant arrhythmia. In these, patients appear to be crucial on immediate and prompt revascularization to prevent fatal outcome. We report a very rare ischemic pattern, with the association of left main coronary artery acute occlusion and a coronary anomaly which contributes to save patient life. 346-7721; E-mail: pirainod@libero.itThe chances of survival may be increased, if between LMCA occlusion and patient's life are interposed with an unexpected coronary anomaly.Coronary artery anomalies are rare and in literature the reported prevalence is about 0.6% to 1.3% [1] in angiographic diagnostic procedure and 0.3% in autopsy series, because many anomalies don't give symptoms during the patient's life (only 20% of patients have symptoms during their life) [2] and their reply is an incidental finding, especially when LMCA is involved, as in our case report, and a very rare anomalous origin of the Circumflex Artery(LCX) from Right Coronary Artery (RCA) plays an important role. Case ReportA-42-year-old cigarette smoking man with chest pain arising for about two hours was admitted to our hospital. No previous cardiac events are reported in his past history. Electrocardiogram (ECG) showed (Figure 1) left bundle branch block (not presented in previous ECGs) and blood test indicated a peak of myocardial necrosis index: cTnI 80 ng/ml. Patient's clinical condition appeared immediately critical, due to the presence of cardiogenic shock, with severe metabolic acidosis, oligoanuria and immediate intubation necessity. Echocardiogram revealed: extended akinesia of anterolateral wall, interventricular septum and apex and ejection fraction 30%.We performed coronary angiography: LMCA acute thrombotic occlusion (without collateral flow from the RCA) and anomalous origin of LCX from RCA (Figures 2 A and B), both without stenosis, so we placed an intra aortic balloon pump (IABP) and proceeded to mechanical thrombus aspiration and Drug-Eluting Stent (DES) implantation (Xience 3 x 15 mm) between the LMCA-Left Anterior Descending Artery (LAD) (Figure 2 C). After three days, stabilization of hemodynamic status, intubation and hemodynamic support by IABP were stopped. Abbreviations

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Section: When the Coronary Anomaly Saves Your Life: A Very Rare Ischesupporting

confidence: 49%

Section: -7721; E-mail: Pirainod@liberoitmentioning

confidence: 99%

When the Coronary Anomaly Saves Your Life: a Very Rare Ischemic Coronary Presentation - Our Cardiac Catheterization Laboratory Experience and New Way of Treatment

Piraino¹

2015

JCTCD

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“…Esses achados Ecocardiograma 171 25 Com alteração 11 Cintilografia miocárdica 145 21 Com alteração 9 Teste de esforço 168 25 Com alteração 11 Cateterismo cardíaco 208 30 Sem exames prévios 253 37 têm importância, particularmente em pessoas jovens. [13][14][15] No entanto o grande desafio da angiotomografia de coronárias é a avaliação das lesões parietais e a detecção de redução do calibre desses vasos.…”

Section: Discussionunclassified

Padrões de indicação da angiotomografia coronária de múltiplos detectores na prática clínica: experiência de um centro de referência

Martins¹,

Yordi²,

Quadros³

et al. 2010

Rev. Bras. Cardiol. Invasiva

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RESUMOIntrodução: A angiotomografia coronária com múltiplos detectores está sendo progressivamente utilizada na prá-tica clínica diária. Não existem estudos em nosso meio analisando o perfil dos pacientes submetidos a esse exame. Método: Estudo de coorte transversal, incluindo pacientes submetidos a angiotomografia coronária com múl-tiplos detectores em um centro de referência por indicação de seu médico assistente. Antes da realização do exame, foram avaliadas a presença de fatores de risco, a apresentação clínica da doença arterial coronária e os exames diagnósticos não-invasivos e invasivos já realizados. Os dados foram analisados com o programa SPSS 13.0. Resultados: A média de idade dos 689 pacientes incluídos foi de 63,7 anos e 52% eram do sexo masculino. Em relação aos fatores de risco, 65% eram hipertensos, 17% eram diabéticos, 9,6% eram fumantes ativos e 63% apresentavam história familiar de doença arterial coronária. Quanto à apresentação clínica, 49% dos pacientes eram assintomáticos, 16% apresentavam dor torácica atípica e 35%, angina. Em relação à avaliação diagnóstica prévia, 25% realizaram ecocardiograma e 21% realizaram cintilografia, e 37% dos pacientes não haviam realizado nenhum desses exames. Menos de 1% dos pacientes encaminhados não apresentava nenhuma dessas características, e a maioria apresentava três ou mais fatores de risco, sendo frequente a combinação dessa característica com exames diagnós-ticos alterados e história de revascularização prévia. Entre os pacientes assintomáticos, 98% apresentavam algum fator de risco e 27% tinham algum exame prévio positivo. Conclusão: A maioria dos pacientes encaminhados para angiotomografia coronária com múltiplos detectores ABSTRACT Multidetector Computed Tomographic Angiography of Coronary Arteries in Daily Clinical Practice: Experience of a Tertiary CenterBackground: Multidetector computed tomographic angiography of coronary arteries has been increasingly used in the daily clinical practice. There are no studies in Brazil analyzing the profile of patients submitted to this new test. Method: Cross-sectional cohort study including patients submitted to multidetector computed tomographic angiography at a reference center and referred by their attending physician. Before angiotomographic evaluation, patients were assessed for the presence of risk factors, clinical presentation and previous results of invasive and non-invasive tests. Data were analyzed using SPSS 13.0. Results: Mean age of the 689 patients was 63.7 years and 52% were men. As to risk factors, 65% were hypertensive, 17% were diabetic, 9.6% were smokers, and 63% had family history of coronary artery disease. As to the clinical presentation of the disease, 49% were asymptomatic, 16% had atypical chest pain and 35% had angina. Twenty-five percent of the patients had echocardiography, 21% had myocardial scintigraphy and 37% had no previous tests. Less than 1% of the patients did not have any of these characteristics and most of them had three or more risk factors, frequently associated to a...

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“…11 Similarly, multi-detector row CCTA has also been shown to accurately depict anomalous origin of coronary arteries in those with equivocal findings at cardiac catheterization or echocardiography. 12 Treatment of significant anomalies should be guided by the nature of the anomalous vessel. The vessel may need surgical reconstruction, decompression, reimplantation in the correct sinus, or bypass with ligation of the native vessel to eliminate competitive flow in the graft.…”

Section: Discussionmentioning

confidence: 99%

Anomalous Origin of Right Coronary Artery

Sheth¹,

Kumar²

2009

TMF

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Anomalous Coronary Arteries in Adults: Depiction at Multi–Detector Row CT Angiography

Cited by 211 publications

References 20 publications

When the Coronary Anomaly Saves Your Life: a Very Rare Ischemic Coronary Presentation - Our Cardiac Catheterization Laboratory Experience and New Way of Treatment

When the Coronary Anomaly Saves Your Life: a Very Rare Ischemic Coronary Presentation - Our Cardiac Catheterization Laboratory Experience and New Way of Treatment

Padrões de indicação da angiotomografia coronária de múltiplos detectores na prática clínica: experiência de um centro de referência

Anomalous Origin of Right Coronary Artery

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