Usefulness of multidetector CT angiography for anomalous origin of coronary artery

Abstract

SUMMARYA 17-year-old man underwent clinical evaluation of exercise-induced syncope. Routine exercise stress test did not show any myocardial ischaemic changes or arrhythmias on the ECG recording. However, multidetector CT (MDCT) angiography of the coronary arteries revealed an abnormal origin of the left coronary artery from the right coronary sinus. The participants' symptoms were diagnosed as cardiogenic syncope possibly due to transient stenosis of the left main coronary artery caught between the functionally distended aortic root and the pulmonary trunk during exercise. After successful patch coronary angioplasty, his symptoms disappeared completely even during a similar degree of strenuous exercise. It is important for clinicians not to overlook possible coronary artery anomalies during management of patients with exercise-induced syncope. MDCT coronary angiography may be a useful and non-invasive tool to establish diagnosis and a surgical approach to rectify congenital coronary artery anomalies. BACKGROUND

Aborted sudden cardiac death associated with an anomalous right coronary artery

“…However, they were unable to detect her congenital aortic abnormality. These tests are frequently normal in this population of patients 11 13…”

“…This non-invasive imaging technology provides exceptional quality of the 3D anatomical coronary images allowing the visualisation of the origin, course and distal portion of these arteries 11. Furthermore, we believe that MDCCT is likely the single best imaging technique today to evaluate patients presenting with cardiovascular symptoms during exercise and routinely in competitive athletes 13 18…”

Valor de la angiografía coronaria por tomografía computarizadaen el diagnóstico de las anomalías coronarias

“…En la actualidad, la ACTC es una técnica de diagnóstico eficaz e ideal para la evaluación de pacientes jóvenes con sintomatología cardiaca y alta sospecha de una AC 10,30 . En este estudio, la paciente 5 que sufrió un colapso cardiovascular por una fibrilación ventricular mientras participaba en una maratón, había comenzado a presentar disnea de esfuerzo dos meses antes del evento.…”

“…Estas anomalías pueden ser una causa de muerte súbita (MCS), especialmente en atletas jóvenes, durante o inmediatamente después de la realización de esfuerzo físico intenso [6][7][8] . A pesar de que la MCS puede ser la primera manifestación de una AC, aproximadamente la mitad de los pacientes portadores de esta cardiopatía tiene síntomas cardiacos: palpitaciones, disnea, angina de esfuerzo o síncope [8][9][10] .…”

Imaging of Left Main Coronary Artery; Untangling the Gordian Knot

“…Indeed, its diagnostic ability was confirmed, as ICA revealed LMCA stenosis of more than 50% in only 2.9% patients without LMCA disease, according to CCTA [ 40 ]. In addition, CCTA could be used in patients with anomalous LMCA origin, in patients suffering from catheter-induced vasospasm, and in those having undergone coronary artery bypass surgery [ 41 , 42 , 43 ]. Last, CCTA has been proven as an acceptable solution for the detection of in-stent stenosis in LMCA.…”