Anomalous origin of coronary artery: taxonomy and clinical implication

Abstract

ObjectiveAnomalous origin of coronary artery is uncommon. The taxonomies of anomalous origin of coronary artery are inconsistent and complex. Conceptual and therapeutic debates remain. The aim of the present study is to reappraise the concept of anomalous origin of coronary artery and to discuss the potential hazards and treatment rationale of this anomaly on basis of literature review.MethodsA comprehensive literature review was made in terms of the taxonomies including “simple”, “multiple” and “complex” types of anomalous origin of coronary artery.ResultsAnomalous origin of coronary artery can be simply categorized according to the ectopically originated coronary artery. There are a couple of complex anatomical variants: “multiple” type, involving more than one coronary artery or branch, which can be subdivided into 2 subtypes, A) more than one coronary arteries or branches arising from one place; and B) two coronary arteries/branches arising from separate ectopic sites; and “complex” type, associated with acquired heart disease, or congenital heart defects.ConclusionSudden cardiac death in anomalous origin of coronary artery is associated with the anatomical features including abnormal coursing, acute angle take-off and ostial abnormalities. Atherosclerosis is prone to be in the right-sided ectopic and retroaortic coursing coronary artery. Surgical treatment is a definitive therapy. Simple coronary artery bypass grafting is not recommended due to the potential hazards of coronary steal phenomenon and poor patency of mammary arterial grafts, and modified maneuvers such as coronary ostial reimplantation, impinged coronary segment unroofing and coronary stent deployment are advocated instead.

Revascularization of Chronic Occlusive Disease of a Right Pulmonary Artery Graft

“…Several different management options include coronary ostial reimplantation, unroofing of impinged coronary artery segment, and coronary stent deployment. [5,6] However, due to the limited number of patients and debates of outcomes and limited information on long-term follow-up, large series of patients are needed to determine a standard of care. [5] During the surgical repair of any vessel, stenosis is a complication that is not unexpected.…”

“…[5,6] However, due to the limited number of patients and debates of outcomes and limited information on long-term follow-up, large series of patients are needed to determine a standard of care. [5] During the surgical repair of any vessel, stenosis is a complication that is not unexpected. Our patient's RPA stenosis was treated with a Dacron stent.…”

Influence of malformation of right coronary artery originating from the left sinus on the hemodynamic environment

“…The RCA originating from the right aortic sinus of the heart supplies blood to the superior and inferior ventricles at the right side of the heart. Anomalous origin of the coronary artery (AAOCA) is a common type of congenital coronary artery anomaly [1]. Although some children are born with AAOCA, it may not be diagnosed during coronary angiography until the individual grows to an adolescent or adult [2][3][4].…”

Sudden cardiac death in the young: cytokines and pathways

“…However, simple coronary artery bypass grafting is not recommended due to the potential hazards of coronary steal phenomenon and poor patency of the mammary arterial grafts. Nevertheless, modified maneuvers, such as coronary ostial reimplantation, impinged coronary segment unroofing and coronary stent de ployment, are advocated instead (46). Surgical treatment of ventricular arrhythmias includes excision of ventricular tachycardia foci and excision of left ventricular aneurysms.…”