Congenital Coronary Artery Anomalies: Three Cases and Brief Review of the Literature

Abstract

Coronary artery anomalies (CAAs) are congenital vascular defects which can remain hidden and asymptomatic over the complete life course of an individual. They are defined as deviations from the normal coronary anatomy regarding the arterial origin, course, or both. Their incidence varies from 1.3% to 5.64% in coronary angiography cohorts, and they can be detected as incidental findings. In certain cases, CAAs can be hemodynamically significant and unfortunately can be proven lethal. Their link with sudden cardiac death, especially in otherwise healthy competitive athletes, is well established, but their prognostic significance, range of symptoms, and pathophysiology remain to be further elucidated. Here, along with a brief review of related literature, we present a series of three cases: one case of an anomalous origin of the right coronary artery (RCA) from the left coronary sinus, one case of a split RCA originating from the left coronary sinus, and one case of a dual left anterior descending (LAD) artery system.

Aberrant Left Coronary Artery Origin in a Patient Presenting With Acute Coronary Syndrome

“…Patients with CAA require careful evaluation, preoperative planning, and intraoperative attention to identify patients with high-risk coronary anatomy and provide optimal care to these patients [ 10 ]. Another case series reported findings of a right anomalous coronary artery arising from the left coronary sinus and dual LAD artery system in patients presenting with ACS.…”

“…Most CAA are benign, although some are associated with high morbidity and mortality, including the origin of the coronary artery from the contralateral coronary sinus, the origin of the coronary artery from the pulmonary artery, and a single coronary artery [3,8]. Patients with anomalous coronary arteries may present with symptoms of angina, syncope, myocardial infarction, heart failure, and sudden cardiac death [8][9][10][11].…”