Congenital anomalies of the coronary arteries: imaging with contrast-enhanced, multidetector computed tomography

Abstract

The objective of this study is to evaluate multidetector CT (MDCT) in detecting and characterizing anomalous coronary arteries. Forty-four patients with anomalies of the coronaries were selected from a total of 1758 individuals examined with ECG-gated 4- and 16-row MDCT including thinMIP, MPR and VRT post-processing. Twenty-eight patients showed origin and course anomalies of the central coronary segments, and in this subgroup 13 were judged as "malignant" because of interarterial courses between the aortic root and the pulmonary trunk, either of the right coronary artery (n=11) or the left coronary artery (n=2). Twelve non-hemodynamic anomalies were found, affecting the coronary origins only (n=10) or the peripheral vessels courses (n=2). Four arteriovenous fistulas were present, all of them with complex arterial feeders. Regardless of vessel anatomy, coronary opacification was always possible by means of the systemic contrast agent, and the aberrant coronary arteries were visualized synoptically in direct relation to the great mediastinal vessels. In contrast to MDCT, selective cannulation and final diagnosis was possible in only 11 of the 20 catheter angiograms performed (accuracy of 55.0%). In conclusion, its non-invasiveness and precise visualization makes MDCT the standard of reference for evaluating anomalous coronary arteries.

Cardiac Vasculature: Development and Pathology

“…Hypertrophic cardiomyopathy should be ruled out using this method. If the echocardiogram raises the suspicion and is unable to provide enough information, a transesophageal echocardiogram, magnetic resonance imaging and/ or CT scan may be more sensitive and should be considered (Schmitt et al, 2005). While the association between sudden death and coronary anomalies has been made for certain such anomalies, no treatment has been established for individuals identified with these anomalies but suffering no symptoms.…”

Role of 256-slice MDCT in the evaluation of coronary artery fistula: A case series with review of literature

“…15 Catheter angiography may not be as efficient and sufficient for the evaluation of complex CAF as it is not able to demonstrate multiple fistulae arising from different segments of coronary arteries. CTCA not only can demonstrate the complex anatomy non-invasively, but also it is easy to do the follow-up studies.…”

Coronary Artery Fistula and Its Imaging Modalities—A Review Article

“…To some extent, it can elucidate the source of CAF along with its size and number. However, these fistulas being dissipitated to low-pressure cardiac chamber and due to marked dilatation of contrast medium, the exit site may not be well visualized [30]. [33].…”