Coronary arteries anomalous aortic origin on a computed tomography angiography population: prevalence, characteristics and clinical impact

Abstract

Anomalous aortic origin of coronary arteries (AAOCA) is one of the most frequent causes of cardiovascular sudden death among the young population. We aimed to determine the prevalence and anatomic characteristics of AAOCA in a population referred to computed tomography angiography (CTA) and to describe the clinical prognosis of these findings at middle term follow-up. From a total of 3539 CTA, 53 were found to have AAOCA. This population was compared to an age and gender matched control group (n = 106) from the same CTA list. A telephone follow-up to determine cardiac events was conducted, with a mean follow-up of 45.9 ± 28.2 months. Prevalence of AAOCA was 1.5 %. The most common AAOCA was an origin of the right coronary artery (RCA) from the left coronary sinus, followed by an origin of the left circumflex artery (LCX) arising from the right coronary sinus. All patients with an anomalous origin of the RCA had an interarterial course. Four additional patients were found to have an interarterial course: 1 with an anomalous origin of LCX and 3 with an anomalous origin of the left main coronary artery (LMCA). At follow-up there were 33 (21.2 %) cardiac events, 9 (17.6 %) on the AAOCA group and 24 (22.9 %) on the control group (p = 0.46). Cardiac events and cardiovascular deaths were not related to any particular AAOCA or to interarterial courses. Among an adult population referred to CTA, AAOCA were not related with worse middle term prognosis when compared to an age- and gender- matched population.

Prevalence and Spectrum of Coronary Anomalies Detected on Coronary Computed Tomography Angiography: A single centre experience in Oman

“…In the current study, ACAOS was the most common CAA (69.5%) which was similar to reports from previous studies 7,11,20,21. ACAOS can be classified into four groups: 1) RCA arising from the LCS, 2) LCA arising from the RCS, 3) LCX or LAD arising from the RCS and 4) LCA or RCA arising from the NCS 6,22. The course of the anomalous artery can be interarterial between the aorta and the MPA, anterior to the MPA, retroaortic or transseptal through the interventricular septum 5,9,13,16.…”

A Single Coronary Artery Originating from the Right Coronary Sinus with a Typical Course of the Right Coronary Artery and the Interarterial Course of the Left Main, Left Anterior Descending, and Left Circumflex as an Example of a Rare Case of High-Risk Coronary Anomaly

“…Described mortality rate is 57% for left-sided ACAOS and 25% for right-sided ACAOS [ 29 ]. In other words, the case where a single coronary artery originates from the right coronary sinus and then divides into the arteries corresponding to RCA and LCA (LCA with interarterial course) is characterized by a higher risk than when a single coronary artery originates from the left coronary sinus (RCA with interarterial course) [ 30 ]. However, there are of course symptomatic cases of right-sided ACAOS.…”

Diagnostic Yield of Non-Invasive Testing in Patients with Anomalous Aortic Origin of Coronary Arteries: A Multicentric Experience

“…We believe that the negative results of echocardiogram may be due primarily to incomplete and not-standardized evaluations, not including the routine assessment of right and left coronary arteries ostia, rather than a real low sensitivity. Previous studies have highlighted how echocardiographic examination of coronary artery ostia can be feasible and reliable in high percentages of young athletes, in which the quality of acoustic windows is generally optimal [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. High expertise, broader experience, and dedicated or standardized protocols are therefore required in the evaluation of coronary arteries in echocardiography in order to increase further the diagnostic accuracy for AAOCA [24,25].…”

“…Furthermore, first-line screening exams like electrocardiogram (ECG) and ECG stress test are too aspecific for a precise diagnosis, and transthoracic echocardiography (TTE) requires high expertise and good experience for the evaluation of coronary arteries [5][6][7][8][9]. In case of high suspicion of AAOCA, coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) imaging are currently the gold standards for diagnosis since they are accurate and precise in defining the anatomic details of the coronary anomaly [10][11][12][13]. Providing a good visualization of the anomalous coronary origin and course is crucial for the effective management of patients with AAOCA.…”