Coronary Arterial Development: A Review of Normal and Congenitally Anomalous Patterns

Abstract

Coronary artery development is a delicate, complex, and finely tuned process that includes multiple interactions among many pathways, especially in the pericardium and the developing myocardium. There still exists some controversy on the exact origin of certain cellular components. Nevertheless, an understanding of this extremely important developmental process is paramount in identifying some of the causes of anomalous coronary development. There are different patterns of anomalous coronary arteries, with variable risk of myocardial ischemia, malignant arrhythmias, and sudden cardiac death. These anomalies can be broadly categorized into 2 basic anatomic subsets: those with origin of the anomalous coronary artery from the opposite aortic sinus, and those with origin of the anomalous coronary artery from the pulmonary artery. Diagnosis and management of such patterns continues to be challenging. A good knowledge of the normal and abnormal coronary artery development could potentially help us explore new avenues in the treatment of ischemic heart disease as well as anomalous coronary arteries.

A 16 year old boy with chest pain

“…Congenital coronary abnormalities can increase the likelihood of myocardial infarction, possibly because of compressive effects of the myocardium on arteries with an aberrant course. 2 The presence of a patent foramen ovale or an atrial septal aneurysm may lead to paradoxical embolism into the coronary circulation, although such cases are extremely rare. 3 Other rare embolic causes of myocardial infarction in young people include septic emboli from endocarditis (left sided) or clots formed around a left atrial myxoma.…”

Imaging of Coronary Artery Anomalies

“…At 6 weeks the vessels are continuous and connected to the aorta. Disruptions in this process are believed to underlie the development of coronary anomalies [ 10 ].…”

Challenges of Anomalous Coronary Artery Intervention: Case Series and a Review

“…Congenital malformation of the coronary arteries not associated with other congenital cardiac defects is referred to as coronary artery anomalies (CAAs) [1]. Typically, the right coronary artery (RCA) originates from the right cusp of the aorta and the left main coronary artery (LM) originates from the left cusp of the aorta further giving rise to the left anterior descending (LAD) and left circumflex arteries (LCx) [2].…”

“…CAAs are frequently clinically silent and are only recognized in presence of concomitant cardiac disease or are found as an incidental finding via imaging or during autopsy [3,4]. Although the prevalence of CAAs is estimated to be anywhere between 0.2-2.4% [1,5,6], a majority of studies investigating the prevalence of CAAs are retrospective and therefore suffer from a selection bias due to the requirement for an indication to perform diagnostic testing.…”