Hemodynamically Significant Anomalies of the Coronary Arteries. Surgical Aspects

Abstract

In 78 (0.9%) of 8,283 patients without associated congenital heart disease studied by angiography, one or more major elements of the coronary arterial system originated in an ectopic manner. Symptoms attributable to the aberrant vessel more present in 20 of the 78 patients and in 15 patients these anomalies were treated surgically. The hemodynamically significant anomalies which lead to abnormalities of myocardial perfusion are of particular surgical importance. There are 4 major types: 1) aberrant origin of the left anterior descending branch from the pulmonary artery; 2) origin of the left coronary artery from the right aortic sinus; 3) origin of the left coronary artery from the pulmonary artery and 4) severe atherosclerotic occlusive disease in an aberrant vessel. The incidence, angiographic features and surgical aspects of these anomalies are discussed.

Anomalous Right Coronary Artery from the Pulmonary Artery: Noninvasive Diagnosis and Serial Evaluation

“…A cardiovascular magnetic resonance (CMR) was performed to evaluate the proximal course of the coronary arteries (Figs. [1][2][3]. The CMR showed extremely dilated epicardial coronary arteries.…”

Coronary Artery Imaging in Grown Up Congenital Heart Disease

“…[1][2][3] It is important to identify coronary anomalies, because arteries that pass between the aorta and pulmonary artery (PA) may be associated with myocardial ischemia and sudden death. 4 -7 The identification of anomalous coronary arteries can be difficult with conventional x-ray angiography, because of the lack of 3-dimensional (3-D) information that relates the course of the coronary arteries to the great vessels.…”

Total anomalous origin of the coronary arteries from the pulmonary artery

“…Since the left aortic sinus of Valsalva is in closer proximity to the septum of the truncus than to the right sinus [3], a far smaller displacement of the left coronary artery anlage will cause the left coronary artery ostium to fall within the pulmonary artery . Abrikossoff's theory, however, fails to explain those cases in which an accessory (third) coronary artery [6,27], or only one branch of the left coronary artery [1, 12,14,30,40,44], arises from the pulmonary artery . The theory also fails to explain why the relative size of the pulmonary artery, aorta, and their valves has not been found to be altered by displacement of the septum .…”

“…Cardiomegaly was present in 56% of cases and the majority of patients had myocardial fibrosis or infarction . Embryology is reviewed and evidence is presented to support the theory of involution-persistence of coronary artery anlagen as the pathogenetic mechanism of TCAPA .KEY WORDS : Coronary vessel anomalies -Congenital heart disease -Coronary artery origin from pulmonary artery Anomalies of the coronary arteries are extremely rare [2,12] . There were 54 (0 .29%) among 18,950 consecutive autopsies, including 39 anomalies of origin and 15 of distribution [2] .…”

“…There were 54 (0 .29%) among 18,950 consecutive autopsies, including 39 anomalies of origin and 15 of distribution [2] . Among 8283 patients without congenital heart disease undergoing angiography because of chest pain, ectopic origin of one or more of the major elements of the coronary arterial system were present in 78 (0 .95%) [12] .All or part of the coronary arterial system may originate from the pulmonary artery . Origin of the left coronary artery from the pulmonary artery (LCAPA) occurs most frequently, with over 460 reported cases [37] .…”