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Coronary artery anomalies detected by MSCT-coronary angiography in the adult

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Abstract

Background. Before coronary evaluation by modern imaging techniques was feasible, premorbid diagnoses of coronary artery anomalies (CAAs) were usually made fortuitously by invasive coronary angiography (ICA). However, this technique is limited by its invasive and projectional nature. Coronary magnetic resonance angiography (CMRA) and multi-slice computed tomography (MSCT) broadened clinical information by enabling visualisation of the coronary arteries in their anatomical environment.

Methods. This case series visualises and reviews anomalous coronary artery from the opposite sinus (ACAOS) and coronary artery fistulae. All CAAs were detected by means of 64-slice dual source computed tomography after 1000 cardiac scans at the Erasmus MC, Rotterdam, the Netherlands.

Results. Eight ACAOS cases, one anomalous left coronary artery from the pulmonary artery (ALCAPA) and one congenital aneurysm of an aortic sinus were found. Seven out often detected CAAs were considered malignant whereas three CAAs of the ACAOS type (retroaortic path) were considered benign. Significant coronary artery disease was found in three out of eight ACAOS cases. In one of the ACAOS cases complete evaluation of the anomalous coronary artery was limited by motion artifacts. All five cases of right ACAOS were referred for MSCT because the right coronary artery could not be located by invasive angiography.

Conclusion. All CAAs were easy to diagnose because of 3D imaging and high temporal and spatial resolution. High resolution made it possible to not only depict coronary artery abnormalities, but also to quantify luminal and vessel properties such as stenosis grade, aspects of plaque, anomalous vessel length, luminal area ratio and the asymmetry ratio. Because of its comprehensiveness, MSCT can be an effective imaging modality in patients suspected of coronary artery abnormalities caused by coronary artery disease, CAAs, or a combination of both. (Neth Heart J 2008;16:369-75.)

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References

  1. De Feyter PJ, Meijboom WB, Weustink A, Van Mieghem C, Mollet NR, Vourvouri E, et al. Spiral multislice computed tomography coronary angiography: a current status report. Clin Cardiol 2007;30:437-42.

    Google Scholar 

  2. Shi H Aschoff AJ, Brambs HJ, Hoffman MH. Multislice CT Imaging of anomalous coronary arteries. Eur Radiol 2004;14:2172-81.

    Google Scholar 

  3. Angelini P. Coronary Artery Anomalies; An Entity in search of an Identity. Circulation 2007;115:1296-305.

    Google Scholar 

  4. Angelini P, Trivellato M, Donis J, Leachman RD. Myocardial bridges: a review. Prog Cardiovasc Dis 1983;26:75-88.

    Google Scholar 

  5. Angelini P, Velasco JA, Ott D, Khoshnevis GR. Anomalous coronary artery arising from the opposite sinus: descriptive features and pathophysiologic mechanisms, as documented by intravascular ultrasonography. J Invasive Cardiol 2003;15:507-14.

    Google Scholar 

  6. Angelini P, Walmsley RP, Libreros A, Ott DA. Symptomatic anomalous origination of left coronary artery from the opposite sinus of valsalva: clinical presentations, diagnosis, and surgical repair. Tex Heart Inst J 2006;33:171-9.

    Google Scholar 

  7. Coronary artery surgery study (CASS): a randomized trial of coronary artery bypass surgery: survival data. Circulation 1983;68:939-50.

    Google Scholar 

  8. Mitchell JH, Haskell W, Snell P, Van Camp SP. Task Force 8: classification of sports. J Am Coll Cardiol 2005;45:1364-7.

    Google Scholar 

  9. Reagan K, Boxt LM, Katz J. Introduction to coronary arterio-graphy. Radiol Clin North Am 1994;32:419-33.

    Google Scholar 

  10. Angelini P, Velasco JA, Flamm S. Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation 2002;105:2449-54.

    Google Scholar 

  11. Angelini P, Villason S, Chan AV, Diez JG. Normal and anomalous coronary arteries in humans. In: Angelini P, editor. Coronary Artery Anomalies: A comprehensive Approach. Philadelphia: Lippincott Williams & Wilkins; 1999:27-150.

  12. Alexander RW, Griffith GC. Anomalies of the coronary arteries and their clinical significance. Circulation 1956:14;800-5.

    Google Scholar 

  13. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990;21:28-40.

    Google Scholar 

  14. Taylor AJ, Virmani R. Coronary Artery Anomalies. In: Crawford MH, DiMarco JP, Paulus W (editors). Cardiology, 2nd ed. New York: Mosby; 2004:201-11.

  15. Perloff JK. Congenital anomalies of the coronary circulation. In: Perloff JK, editor. The Clinical Recognition of Congenital Heart disease, 4th ed. Philadelphia: WB Saunders; 1994:738.

  16. Geuns van RJ, Cadematiri F. Anatomy of the coronary arteries and vein in CT imaging. In: Schoepf UJ, editor. CT of the heart. Totowa, NJ: Humana, 2005; 219-28.

  17. Cheitlin MD, De Castro CM, Mc Allister HA. Sudden death as a complication of anomalous left coronary origin of the anterior sinus ofValsalva: a not-so-minor congenital anomaly. Circulation 1974;50:780-7.

    Google Scholar 

  18. Dodge-Khatami A, Mavroudis C, Backer CL. Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy. Ann Thorac Surg 2002;74:946-55.

    Google Scholar 

  19. Williams IA, Gersony WM, Hellenbrand WE. Anomalous right coronary artery arising from the pulmonary artery: A report of 7 cases and a review of the literature. Am Heart J 2006;152:1004.e9-1004e17.

    Google Scholar 

  20. Su JT, Krishnamurthy R, Chung T, G Wesley Vick, Kovalchin JP. Anomalous Right Coronary Artery from the Pulmonary Artery: Noninvasive Diagnosis and Serial Evaluation. J Cardiovasc Magn Res 2007;9:57-62.

    Google Scholar 

  21. 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 140 cases with seven further cases. Circulation 1968;38:403-25.

    Google Scholar 

  22. Frescura C, Basso C, Thiene G, Corrado D, Pennelli T, Angelini A, et al. Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol 1998;29:689-95.

    Google Scholar 

  23. Taylor AJ, Rogan KM,Virmani R. Sudden cardiac death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol 1992;20:640-7.

    Google Scholar 

  24. Zanzonico P, Rothenberg LN, Strauss HW. Radiation exposure of computed tomography and direct intracoronary angiography: risk has its reward. J Am Coll Cardiol 2006;47:1846-9.

    Google Scholar 

  25. Angelini P, Flamm SD. Newer Concepts for Imaging Anomalous Aortic Origin of the Coronary Arteries in Adults. Cath Cardiovasc Int 2007;69:942-54.

    Google Scholar 

  26. Cademartiri F, La Grutta L, Malagò, Alberghina F, Meijboom WB, Pugliese F, et al. Prevalence of anatomical variants and coronary anomalies in 543 consecutive patients studied with 64-slice CT coronary angiography. Eur Radiol 2008;18:781-91.

  27. Fernandes F, Alam M, Smith S, Khaja F. The role of transeso-phageal echocardiography in identifying anomalous coronary arteries. Circulation 1993;88:2532-40.

    Google Scholar 

  28. Bunce NH, Lorenz CH, John AS, Lesser JR, Mohiaddin RH, Pennell DJ. Coronary artery anomalies: Assessment with free-breathing three dimensional coronary MR angiography. Radiology 2003;227:201-8.

    Google Scholar 

  29. Nemes A, Geleijnse ML, van Geuns RJ, Soliman OI, Vletter WB, Krenning BJ, et al. Dobutamine stress MRI versus threedimen-sional contrast echocardiography: It's all Black and White. Neth Heart J 2008;16:217-8.

    Google Scholar 

  30. Mc Connell MV, Ganz P, Selwyn AP, Li W, Edelman RR, Manning WJ. Identification of anomalous coronary arteries and their anatomic course by magnetic resonance coronary angiography. Circulation 1995;92:3158-62.

    Google Scholar 

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Correspondence to G. J. R. ten Kate.

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Department of Radiology, Erasmus MC, Rotterdam, the Netherlands

G.J.R. ten Kate Department of Radiology, Erasmus MC, PO Box 2040, 2000 CB Rotterdam, the Netherlands

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Kate, G.J.R.t., Weustink, A.C. & de Feyter, P.J. Coronary artery anomalies detected by MSCT-coronary angiography in the adult. NHJL 16, 369–375 (2008). https://doi.org/10.1007/BF03086181

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