Prevalence and characteristics of coronary artery anomalies in an adult population undergoing multidetector-row computed tomography for the evaluation of coronary artery disease

Abstract

BackgroundCongenital coronary anomalies are uncommon with an incidence ranging from 0.17 % in autopsy cases to 1.2 % in angiographically evaluated cases. The recent development of ECG–gated multi–detector row computed tomography (MDCT) coronary angiography allows accurate and noninvasive depiction of coronary artery anomalies.MethodsThis retrospective study included 2572 patients who underwent coronary 64-slice MDCT coronary angiography from January 2008 to March 2012. Coronary angiographic scans were obtained with injection of 80 ml nonionic contrast medium. Retrospective gating technique was used to synchronize data reconstruction with the ECG signal. Maximum intensity projection, multi-planar reformatted, and volume rendering images were derived from axial scans.ResultsOf the 2572 patients, sixty (2.33 %) were diagnosed with coronary artery anomalies (CAAs), with a mean age of 53.6 ± 11.8 years (range 29–80 years). High take-off of the RCA was seen in 16 patients (0.62 %), of the left main coronary artery (LMCA) in 2 patients (0.08 %) and both of them in 2 patients (0.08 %). Separate origin of the left anterior descending artery (LAD) and left circumflex artery (LCx) from left sinus of Valsalva (LSV) was found in 15 patients (an incidence of 0.58 %). In 9 patients (0.35 %) the right coronary artery (RCA) arose from the opposite sinus of Valsalva with a separate ostium. In 6 patients (0.23 %) an abnormal origin of LCX from the right sinus of Valsalva (RSV) was found with a further posterior course within the atrioventricular groove. A single coronary artery was seen in 3 patients (0.12 %). It originated from the right sinus of Valsalva in one patient and from LSV in two patients. In two other patients (0.08 %) the left coronary trunk originated from the RSV with separate ostium from the RCA. LCA originating from the pulmonary artery was found in one patient (0.04 %). A coronary artery fistula, which is a termination anomaly, was detected in 4 patients (0.15 %).DiscussionAlthough these anomalies, which are remarkably different from the normal structure, exist as early as birth, they are incidentally encountered during selective angiography or at autopsy. The incidence in reported angiographic series ranges from 0.6 % to 1.3 %. Variations in the frequency of primary congenital coronary anomalies may possibly have a genetic background. The largest angiographic series of 126595 patients, by Yamanaka and Hobbs, reported a 1.3 % incidence of anomalous coronary artery.ConclusionThe results of this study support the use MDCT coronary angiography as a safe and effective noninvasive imaging modality for defining CAAs in an appropriate clinical setting, providing detailed three-dimensional anatomic information that may be difficult to obtain with invasive angiography.

Intravascular Ultrasound guided Percutaneous Coronary Intervention for the Ostial Lesion of the Anomalous Left Circumflex Artery Originated from Left Coronary Cusp Directly

“…The separate origin of the LAD and LCX from the LCC is a rare congenital anomaly with a prevalence of 0.29%-0.69% [1][2][3][4]. PCI for an ostial lesion of an anomalous LCX originating from the LCC is challenging because it is difficult to correctly determine the position of the ostium.…”

“…A separate origin of the left anterior descending (LAD) and left circumflex artery (LCX) from the left coronary cusp (LCC) is a rare congenital anomaly and is found in 0.29%-0.69% of coronary angiography or computed tomography cases [1][2][3][4]. However, reports of percutaneous coronary intervention (PCI) for an anomalous LCX originating from the LCC are scarce.…”

Unusual presentation of right coronary artery fistula

“…Coronary artery fistulas are uncommon, often incidental findings on angiography or autopsy, accounting for 0.15% of CT coronary angiography,1 0.1% of cardiac catheterisation2 and 0.002% of the general population 3. The most common site is the RCA (55%), followed by the left anterior descending artery 4 5.…”

Anomalous coronary arteries: What we know and what we do not know

“…2 That distribution was slightly different, perhaps due to either or both the sample size or age (12-93), in a Polish CTA study of 8522 subjects, aged 12-93, in which both a Left main/LAD ACAOS and Right ACAOS were found in 0.23% of the population. In that study, 24 of the 40 subjects (60%) with an ACAOS showed an interarterial course.…”

“…Contemporary imaging studies have demonstrated a prevalence of 1.3% in the largest direct angiographic series (n = 126,595), from 1960 to 1988 at the Cleveland Clinic, 1 2.33% in a recent consecutive CT coronary angiographic series of 2572 patients from Greece, 2 and 0.3% in 59,844 cardiac magnetic resonance scans from England. 3 Furthermore, not all of the anomalies identified in those studies were of clinical relevance to the patients.…”