Applicability of the Leiden Convention and the Lipton Classification in Patients with a Single Coronary Artery in the Setting of Congenital Heart Disease

Abstract

In single coronary artery (SCA) anatomy, all coronary tributaries arise from a single ostium, providing perfusion to the entire myocardium. Coronary classification systems can facilitate the description of SCA anatomy. Aim: Evaluation of the applicability of Lipton classification and the Leiden Convention coronary coding system in SCA. Methods: All patients (n = 6209) who underwent computed tomography (CT) scanning between 2014 and 2018 were retrospectively examined for the presence of SCA and classified, according to Lipton classification and the Leiden Convention coronary coding system. Results: The prevalence of SCA was 0.51% (32/6209). Twenty-eight patients (87.5%) had coexisting congenital heart disease (CHD), most frequently pulmonary atresia (9/32, 28.1%). Ten patients (10/32, 31.25%) could not be classified with either the Leiden Convention or Lipton classification (pulmonary atresia n = 9, common arterial trunk (CAT) n = 1). In one case with CAT, Lipton classification, but not the Leiden Convention, could be applied. In two cases with the transposition of the great arteries and in two cases of double outlet right ventricle, the Leiden Convention, but not the Lipton classification, could be applied. Conclusions: Both classifications are useful to detail information about SCA. As Lipton classification was not developed for structural heart disease cases, in complex CHD with abnormal position of the great arteries, the Leiden Convention is better applicable. The use of both systems is limited in pulmonary atresia. In this scenario, it is better to provide a precise description of the coronary origin and associated characteristics that might affect treatment and prognosis.

Detection of Coronary Artery and Aortic Arch Anomalies in Patients with Tetralogy of Fallot Using CT Angiography

“…In this classification system, the aortic sinuses are described as left- or right-facing or non-facing relative to the pulmonary valve sinuses; therefore, the applicability is limited in cases of pulmonary atresia. In such cases, a detailed description of the coronary anatomy, as well as associated characteristics, should be provided for treatment planning [ 23 ].…”

A rare case of isolated single coronary artery, Lipton's type LIIB diagnosed by computed tomography coronary angiography

“…Coronary artery anomalies can be divided into anomalies of origin and course, anomalies of intrinsic coronary anatomy, and anomalies of termination [1] . Single coronary artery (SCA) supplying the entire heart is a very rare coronary artery anomaly of origin and course with reported prevalence of 0.024%-0.066% in the population who undergo routine coronary angiography [3 , 4] . SCA can be present in isolation or in association with other congenital cardiac anomalies [3] .…”