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European Radiology

, Volume 24, Issue 10, pp 2353–2359 | Cite as

Anomalous origin of the coronary artery from the wrong coronary sinus evaluated with computed tomography: “High-risk” anatomy and its clinical relevance

  • Maciej KrupińskiEmail author
  • Małgorzata Urbańczyk-Zawadzka
  • Bartosz Laskowicz
  • Małgorzata Irzyk
  • Robert Banyś
  • Piotr Klimeczek
  • Katarzyna Gruszczyńska
  • Jan Baron
Cardiac

Abstract

Objective

The aim of the study was to assess coronary arteries arising from the wrong coronary sinus, including CT-evaluated high-risk anatomic features, clinical symptoms and cardiac events during follow-up.

Methods

A total of 7,115 patients scheduled for 64-slice or dual-source cardiac CT were screened for the presence of isolated anomalous origin of the coronary artery from the wrong coronary sinus.

Results

Anomalous origin of the coronary artery was found in 54 (0.76 %) patients (29 men, 25 women, mean age 60.9 ± 11.6 years). Sixteen (30 %) patients with abnormal right coronary origin (ARCA) more commonly had a slit-like orifice (15 vs. 3; p < 0.001), intramural course (15 vs. 3; p < 0.001) and interarterial course (11 vs. 0; p < 0.001) than 22 (41 %) and 13 (24 %) individuals with abnormal circumflex artery (ALCx) and left coronary artery (ALCA) origin, respectively. Patients with ALCA presented less frequently with chest pain than subjects with ARCA and ALCx (25 vs. 3; p = 0.03). Patients with ARCA tended to show higher occurrence of cardiac events in the follow-up than individuals with ALCA and ALCx (5 vs. 4; p = NS).

Conclusions

High-risk anatomy features are most common in patients with ARCA and these patients also have higher prevalence of chest pain and cardiac events in the follow-up than individuals with ALCA and ALCx.

Key Points

Multislice computed tomography enables detection and evaluation of the coronary artery anomalies.

Anomalous anatomy of the coronary artery potentially influences the prevalence of adverse events.

Adverse events tend to be most common in anomalous right coronary arteries.

Keywords

Multislice computed tomography Coronary vessel anomalies Follow-up studies Cardiovascular abnormalities Anatomy 

Abbreviations

ALCx

Anomalous origin of the circumflex artery from the right coronary artery sinus

ARCA

Anomalous origin of the right coronary artery from the left coronary artery sinus

ALCA

anomalous origin of the left coronary artery from the right coronary artery sinus

CABG

Coronary artery bypass grafting

ICA

Invasive coronary angiography

PCI

Percutaneous coronary interventions

Notes

Acknowledgements

The scientific guarantor of this publication is Dr Małgorzata Urbańczyk-Zawadzka, Head of the Department of Radiology and Diagnostic Imaging, John Paul II Hospital, Krakow, Poland. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval and written informed consent were not required because this is a primarily retrospective study. In the follow-up patients were contacted and asked if any cardiac events had occurred. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

References

  1. 1.
    Angelini P, Velasco JA, Flamm S (2002) Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation 105:2449–2454PubMedCrossRefGoogle Scholar
  2. 2.
    Alexander RW, Griffith GC (1956) Anomalies of the coronary arteries and their clinical significance. Circulation 14:800–805PubMedCrossRefGoogle Scholar
  3. 3.
    Yamanaka O, Hobbs RE (1990) Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Catheter Cardiovasc Diagn 21:28–40CrossRefGoogle Scholar
  4. 4.
    Davis JA, Cecchin F, Jones TK, Portman MA (2001) Major coronary artery anomalies in a pediatric population: incidence and clinical importance. J Am Coll Cardiol 37:593–597PubMedCrossRefGoogle Scholar
  5. 5.
    Kardos A, Babai L, Rudas L et al (1997) Epidemiology of congenital coronary artery anomalies: a coronary arteriography study on a central European population. Catheter Cardiovasc Diagn 42:270–275CrossRefGoogle Scholar
  6. 6.
    Basso C, Maron BJ, Corrado D, Thiene GJ (2000) Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. Am Coll Cardiol 35:1493–1501CrossRefGoogle Scholar
  7. 7.
    Taylor AJ, Byers JP, Cheitlin MD, Virmani R (1997) 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 133:428–435PubMedCrossRefGoogle Scholar
  8. 8.
    Steinberger J, Lucas RV Jr, Edwards JE, Titus JL (1996) Causes of sudden unexpected cardiac death in the first two decades of life. Am J Cardiol 77:992–995PubMedCrossRefGoogle Scholar
  9. 9.
    Kaushal S, Backer CL, Popescu AR et al (2011) Intramural coronary length correlates with symptoms in patients with anomalous aortic origin of the coronary artery. Ann Thorac Surg 92:986–991PubMedCrossRefGoogle Scholar
  10. 10.
    Frescura C, Basso C, Thiene G et al (1998) Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol 29:689–695PubMedCrossRefGoogle Scholar
  11. 11.
    Cademartiri F, Casolo G, Midiri M (2008) Clinical applications of cardiac CT. Springer-Verlag, BerlinGoogle Scholar
  12. 12.
    Kaiser C, Bremerich J, Haller S, Brunner-La Rocca HP, Bongartz G, Pfisterer M, Buser P (2005) Limited diagnostic yield of non-invasive coronary angiography by 16-slice multi-detector spiral computed tomography in routine patients referred for evaluation of coronary artery disease. Eur Heart J 26:1987–1992PubMedCrossRefGoogle Scholar
  13. 13.
    Montaudon M, Latrabe V, Iriart X, Caix P, Laurent F (2007) Congenital coronary arteries anomalies: review of the literature and multidetector computed tomography (MDCT)-appearance. Surg Radiol Anat 29:343–355PubMedCrossRefGoogle Scholar
  14. 14.
    Kayalar N, Burkhart HM, Dearani JA, Cetta F, Schaff HV (2009) Congenital coronary anomalies and surgical treatment. Congenit Heart Dis 4:239–251PubMedCrossRefGoogle Scholar
  15. 15.
    Samarendra P, Kumari S, Hafeez M et al (2001) Anomalous circumflex coronary artery: benign or predisposed to selective atherosclerosis. Angiology 52:521–526PubMedCrossRefGoogle Scholar
  16. 16.
    Warnes CA, Williams RG, Bashore TM et al (2008) ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). Circulation 118:2395–2451PubMedCrossRefGoogle Scholar
  17. 17.
    Shi H, Aschoff AJ, Brambs HJ, Hoffmann MH (2004) Multislice CT imaging of anomalous coronary arteries. Eur Radiol 12:2172–2181CrossRefGoogle Scholar
  18. 18.
    Ooijen PA, Dorgelo J, Zijlstra F, Oudkerk M (2004) Detection, visualization and evaluation of anomalous coronary anatomy on 16-slice multidetector-row CT. Eur Radiol 12:2163–2171CrossRefGoogle Scholar
  19. 19.
    Schmitt R, Froehner S, Brunn J et al (2005) Congenital anomalies of the coronary arteries: imaging with contrast-enhanced, multidetector computed tomography. Eur Radiol 6:1110–1121CrossRefGoogle Scholar
  20. 20.
    Cademartiri F, La Grutta L, Malagò R et al (2008) Prevalence of anatomical variants and coronary anomalies in 543 consecutive patients studied with 64-slice CT coronary angiography. Eur Radiol 4:781–791CrossRefGoogle Scholar
  21. 21.
    Jonge GJ, Ooijen PA, Piers LH et al (2008) Visualization of anomalous coronary arteries on dual-source computed tomography. Eur Radiol 11:2425–2432CrossRefGoogle Scholar
  22. 22.
    Bischoff B, Hein F, Meyer T, Krebs M, Hadamitzky M, Martinoff S, Schömig A, Hausleiter J (2010) Comparison of sequential and helical scanning for radiation dose and image quality: results of the Prospective Multicenter Study on Radiation Dose Estimates of Cardiac CT Angiography (PROTECTION) I Study. AJR Am J Roentgenol 194:1495–1499PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Maciej Krupiński
    • 1
    Email author
  • Małgorzata Urbańczyk-Zawadzka
    • 1
  • Bartosz Laskowicz
    • 1
  • Małgorzata Irzyk
    • 1
  • Robert Banyś
    • 1
  • Piotr Klimeczek
    • 1
  • Katarzyna Gruszczyńska
    • 2
  • Jan Baron
    • 2
  1. 1.Department of Radiology and Diagnostic ImagingJohn Paul II HospitalKrakówPoland
  2. 2.Department of Radiology and Nuclear MedicineMedical University of SilesiaKatowicePoland

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