Skip to main content
SpringerLink
Log in

Anomalies of the Coronary Arteries

  • Chapter
  • First Online:
Critical Care of Children with Heart Disease

  • 1478 Accesses

Abstract

Coronary anomalies are the second leading cause of cardiac death in young athletes and have an overall prevalence reported as high as 2–3%. Isolated abnormalities of the coronary arteries are rare in children with an incidence of less than 0.3 to 1%. Some coronary anomalies are innocuous, while others can be very serious defects with risk of catastrophic cardiac adverse events. Coronary anomalies may be classified by anomalies of origin, course, and termination. Clinical presentation may be sudden cardiac events such as sudden cardiac death, ventricular arrhythmia, syncope, or insidious, as with chronic ischemia, heart failure, valvar insufficiency, and atrial arrhythmia. In this chapter, we will concentrate on those anomalies that often have pathologic significance, namely, the anomalous aortic origin of the coronary artery (AAOCA), the anomalous left coronary artery arising from the pulmonary artery (ALCAPA), and the coronary artery fistula.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Tuo G, Marasini M, Brunelli C, Zannini L, Balbi M. Incidence and clinical relevance of primary congenital anomalies of the coronary arteries in children and adults. Cardiol Young. 2013. https://doi.org/10.1017/S1047951112000959

  2. Rittenhouse EA, Doty DB, Ehrenhaft JL. Congenital coronary artery—cardiac chamber fistula: review of operative management. Ann Thorac Surg. 1975;20:468–485.

    Article  CAS  Google Scholar 

  3. Said S, El Gamal M, Van der Werf T. Coronary arteriovenous fistulas: collective review and management of six new cases--changing etiology, presentation, and treatment strategy. Clin Cardiol. 1997;20:748–752.

    Article  CAS  Google Scholar 

  4. Wesselhoeft H, Fawcett JS, Johnson AL. Anomalous origin of the left coronary artery from the pulmonary trunk. Its clinical spectrum, pathology, and pathophysiology, based on a review of 140 cases with seven further cases. Circulation. 1968;38:403–425.

    Article  CAS  Google Scholar 

  5. Mirchandani S, Phoon CKL. Management of anomalous coronary arteries from the contralateral sinus. Int J Cardiol. 2005;102:383–389.

    Article  Google Scholar 

  6. Taylor AJ, Byers JP, Cheitlin MD, Virmani R. Anomalous right or left coronary artery from the contralateral coronary sinus: ‘High-risk’ abnormalities in the initial coronary artery course and heterogeneous clinical outcomes. Am Heart J. 1997;133:428–435.

    Article  CAS  Google Scholar 

  7. Cheitlin MD. Finding asymptomatic people with a coronary artery arising from the wrong sinus of valsalva: consequences arising from knowing the anomaly to be familial. J Am Coll Cardiol. 2008;51:2065–2067.

    Article  Google Scholar 

  8. Liberthson RR, Sagar K, Berkoben JP, Weintraub RM, Levine FH. Congenital coronary arteriovenous fistula. Report of 13 patients, review of the literature and delineation of management. Circulation. 1979;59:849–854.

    Article  CAS  Google Scholar 

  9. Bland E, White P, Garland J. Congenital anomalies of the coronary arteries: Report of an unusual case associated with cardiac hypertrophy. Am Heart J. 1933;8.

    Google Scholar 

  10. Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Col. Cardiol. 2000;35:1493–1501.

    Article  CAS  Google Scholar 

  11. Robert E. Eckart, DO; Stephanie L. Scoville, DrPH; Charles L. Campbell, MD; Eric A. Shry, MD; Karl C. Stajduhar, MD; Robert N. Potter, DVM, MPH; Lisa A. Pearse, MD, MPH; and Renu Virmani, M. Sudden death in young adults: a 25-year review of autopsies in Annals of Internal Medicine Article. Ann Intern Med. 2004;141:829–834.

    Article  Google Scholar 

  12. Silverman NH. Echocardiographic presentation of anomalous origin of the left coronary artery from the pulmonary artery. Cardiol Young. 2015;25:1512–1523.

    Article  Google Scholar 

  13. Lorber R, et al. Anomalous aortic origin of coronary arteries in the young. JACC Cardiovasc Imaging. 2015;8:1239–1249.

    Article  Google Scholar 

  14. Brothers JA, et al. Expert consensus guidelines: Anomalous aortic origin of a coronary artery. J Thorac Cardiovasc Surg. 2017;153:1440–1457.

    Article  Google Scholar 

  15. Rajiah P, Tandon A, Greil GF, Abbara S. Update on the role of cardiac magnetic resonance imaging in congenital heart disease. Curr Treat Options Cardiovasc Med. 2017;19(2):

    Google Scholar 

  16. Hejmadi A, Sahn DJ. What is the most effective method of detecting anomalous coronary origin in symptomatic patients? J Am Coll Cardiol. 2003;42:155–157.

    Article  Google Scholar 

  17. Angelini P, Flamm SD. Newer concepts for imaging anomalous aortic origin of the coronary arteries in adults. Catheter Cardiovasc Interv. 2007;69:942–954.

    Article  Google Scholar 

  18. Ripley DP, et al. The distribution and prognosis of anomalous coronary arteries identified by cardiovascular magnetic resonance: 15 year experience from two tertiary centres. J Cardiovasc Magn Reson. 2014;16:1–8.

    Article  Google Scholar 

  19. Budoff MJ, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. 2008;52:1724–1732.

    Google Scholar 

  20. Pasquini L, Parness IA, Colan SD, et al. Diagnosis of intramural coronary artery in transposition of the great arteries using two-dimensional echocardiography. Circulation. 1993;88:1136–1141.

    Article  CAS  Google Scholar 

  21. Manghat NE, Morgan-Hughes GJ, Marshall AJ, Roobottom CA. Multidetector row computed tomography: imaging congenital coronary artery anomalies in adults. Heart. 2005;91:1515–1522.

    Article  CAS  Google Scholar 

  22. Warnes CA, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). 2008;118:e714–e833.

    Google Scholar 

  23. Sabiston DC, Orme SK. Congenital origin of the left coronary artery from the pulmonary artery. J Cardiovasc Surg (Torino). 9:543–552.

    Google Scholar 

  24. Jaggers, J. & Lodge, A. J. Surgical therapy for anomalous aortic origin of the coronary arteries. 2005. https://doi.org/10.1053/j.pcsu.2005.01.004

  25. Romp RL, et al. Outcome of Unroofing Procedure For Repair of Anomalous Aortic Origin of Left or Right Coronary Artery. 2003.

    Book  Google Scholar 

  26. Karl TR, Provenzano SCJ, Nunn GR. Anomalous aortic origin of a coronary artery: a universally applicable surgical strategy. Cardiol Young. 2010;20(Suppl 3):44–49.

    Article  Google Scholar 

  27. Alphonso N, et al. Anomalous coronary artery from the wrong sinus of valsalva: a physiologic repair strategy. 2007. https://doi.org/10.1016/j.athoracsur.2006.10.071

  28. Mainwaring RD, et al. Anomalous aortic origin of a coronary artery: medium-term results after surgical repair in 50 patients. 2011. https://doi.org/10.1016/j.athoracsur.2011.03.127

  29. Krasuski RA, et al. Long-term outcome and impact of surgery on adults with coronary arteries originating from the opposite coronary cusp. 2011. https://doi.org/10.1161/CIRCULATIONAHA.109.921106

  30. Sunder KRS, et al. Coronary artery fistula in children and adults: a review of 25 cases with long-term observations. Int J Cardiol. 1997;58:47–53.

    Article  CAS  Google Scholar 

  31. Valente AM, et al. Predictors of long-term adverse outcomes in patients with congenital coronary artery fistulae. Circ Cardiovasc Interv. 2010;3:134–139.

    Article  Google Scholar 

  32. Karimi M, Kirshbom PM. Anomalous origins of coronary arteries from the pulmonary artery: a comprehensive review of literature and surgical options. World J Pediatr Congenit Heart Surg. 2015;6:526–540.

    Article  Google Scholar 

  33. Mitten MJ, Zipes DP, Maron BJ, Bryant WJ. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 15: legal aspects of medical eligibility and disqualification recommendations. Circulation. 2015;132:e346–e349.

    Article  Google Scholar 

  34. Brothers JA, et al. Evaluation of myocardial ischemia after surgical repair of anomalous aortic origin of a coronary artery in a series of pediatric patients. J Am Coll Cardiol. 2007;50:2078–2082.

    Article  Google Scholar 

  35. Nees SN, et al. Patients with anomalous aortic origin of the coronary artery remain at risk after surgical repair. J Thorac Cardiovasc Surg. 2018;155:2554–2564.e3.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. cMRI and Clinical Informatics, Heart Institute, Aurora, CO, USA

    Brian Fonseca

  2. Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, CO, USA

    Brian Fonseca

  3. Associate Medical Director, CHCO Heart Institute, Head, Pediatric Cardiac Critical Care Program & Inpatient Services, Director, Cardiac Intensive Care Unit, Children’s Hospital Colorado, Tenured Professor of Pediatrics, Pediatric Cardiology and Intensive Care, University of Colorado Denver, School of Medicine, Aurora, CO, USA

    Eduardo M. da Cruz

  4. Heart Institute, Aurora, CO, USA

    James Jaggers

  5. Pediatric Cardiothoracic Surgery, Children’s Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, CO, USA

    James Jaggers

Authors
  1. Brian Fonseca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eduardo M. da Cruz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James Jaggers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian Fonseca .

Editor information

Editors and Affiliations

  1. Chief, Division of Cardiac Critical Care Medicine Executive Director, Telemedicine Co-director, Children’s National Heart Institute, Professor of Pediatrics, George Washington University School of Medicine, Children’s National Health System, Washington, DC, USA

    Ricardo A. Munoz

  2. Department of Pediatric Cardiothoracic Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Victor O. Morell

  3. Associate Medical Director, CHCO Heart Institute Head, Pediatric Cardiac Critical Care Program & Inpatient Services Director, Cardiac Intensive Care Unit Children’s Hospital Colorado, Tenured Professor of Pediatrics, Pediatric Cardiology and Intensive Care University of Colorado Denver, School of Medicine, Aurora, CO, USA

    Eduardo M. da Cruz

  4. Department of Pharmacy, Pediatric Critical Care, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Carol G. Vetterly

  5. Department of Pediatric Cardiothoracic Surgery, UPMC – Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Jose Pedro da Silva

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Fonseca, B., da Cruz, E.M., Jaggers, J. (2020). Anomalies of the Coronary Arteries. In: Munoz, R., Morell, V., da Cruz, E., Vetterly, C., da Silva, J. (eds) Critical Care of Children with Heart Disease . Springer, Cham. https://doi.org/10.1007/978-3-030-21870-6_37

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-21870-6_37

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-21869-0

  • Online ISBN: 978-3-030-21870-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation