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Anomalous coronary arteries in adults detected by multislice computed tomography: presentation of cases from multicenter registry and review of the literature

Heart and Vessels volume 23, pages 26–34 (2008)Cite this article

Abstract

Anomalous coronary arteries are a rare condition, but they may cause myocardial ischemia, heart failure, and sudden death. We evaluated the prevalence and multislice computed tomographic (MSCT) findings of anomalous coronary arteries in a large number of patients from the multicenter registry. At four institutes, 29 (0.74%) out of 3910 patients were found to have anomalous coronary arteries by MSCT. They consisted of 15 patients with anomalous origins of the right coronary artery, 1 with right-sided origin of the left circumflex artery, 1 with right-sided origin of the left main coronary artery, 2 with double right coronary arteries, 2 with the absence of the left circumflex artery, 1 with absence of the right coronary artery, 6 with coronary artery fistulas, and 1 with Bland-White-Garland syndrome. Multislice computed tomography findings were consistent with those obtained by conventional coronary angiography in all 14 patients undergoing both diagnostic procedures. Multislice computed tomography permits three-dimensional comprehension of coronary arteries, which is suitable for the diagnosis of anomalous coronary arteries.

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References

  1. Roberts WC (1986) Major anomalies of coronary arterial origin seen in adulthood. Am Heart J 111:941–963

    Article  PubMed  CAS  Google Scholar 

  2. Click RL, Holmes DR, Vlietstra RE, Kosinski AS, Kronmal RA (1989) Anomalous coronary arteries: location, degree of atherosclerosis and effect on survival: a report from the Coronary Artery Surgery Study. J Am Coll Cardiol 13:531–537

    PubMed  CAS  Google Scholar 

  3. Yamanaka O, Hobbs RE (1990) Coronary artery anomalies in 125, 595 patients undergoing coronary angiography. Cathet Cardiovasc Diagn 21:28–40

    Article  PubMed  CAS  Google Scholar 

  4. van Ooijen PM, Dorgelo J, Zijlstra F, Oudkerk M (2004) Detection, visualization and evaluation of anomalous coronary anatomy on 16-slice multidetector-row CT. Eur Radiol 14:2163–2171

    Article  PubMed  Google Scholar 

  5. Sato Y, Inoue F, Matsumoto N, Tani S, Takayama T, Kunimasa T, Takayama T, Yoda S, Kunimasa T, Ishii N, Uchiyama T, Saito S, Tanaka H, Furuhashi S, Takahashi M, Koyama Y (2005) Detection of anomalous origins of the coronary artery by means of multislice computed tomography. Circ J 69:320–324

    Article  PubMed  Google Scholar 

  6. Sato Y, Inoue F, Kunimasa T, Matsumoto N, Yoda S, Tani S, Takayama T, Uchiyanma T, Tanaka H, Furuhashi S, Takahashi M, Koyama Y, Saito S (2005) Diagnosis of the anomalous origin of the right coronary artery using multislice computed tomography: evaluation of possible mechanisms of myocardial ischemia. Heart Vessels 20:298–300

    Article  PubMed  Google Scholar 

  7. Datta J, White CS, Gilkeson RC, Meyer CA, Kansal S, Jani ML, Arildsen RC, Read K (2005) Anomalous coronary arteries in adults: depiction at multi-detector row CT angiography. Radiology 235:812–818

    Article  PubMed  Google Scholar 

  8. Erdogan N, Akar N, Vural M, Canbay A, Kayhan T, Sahin D, Diker E, Aydogdu S (2006) Diagnostic value of 16-slice multidetector computed tomography in symptomatic patients with suspected significant obstructive coronary artery disease. Heart Vessels 21:278–284

    Article  PubMed  Google Scholar 

  9. Sato Y, Kanmatsuse K, Inoue F, Horie T, Kato M, Kusama J, Yoshimura A, Imazeki T, Furuhashi S, Takahashi M (2003) Noninvasive coronary artery imaging by means of multislice computed tomography: a novel approach for retrospectively ECG-gated reconstruction technique. Circ J 67:107–111

    Article  PubMed  Google Scholar 

  10. Sato Y, Matsumoto N, Kato M, Inoue F, Imazeki T, Kusama J, Yoshimura A, Imazeki T, hukui T, Furuhashi S, Takahashi M, Kanmatsuse K (2003) Noninvasive assessment of coronary artery disease by multislice spiral computed tomography using a new retrospectively ECG-gated image reconstruction technique: comparison with angiographic results. Circ J 67:401–405

    Article  PubMed  Google Scholar 

  11. Sato Y, Inoue F, Imazeki T, Yoshimura A, Kusama J, Kato M, Horie T, Matsumoto N, Hori Y, Furuhashi S, Takahashi M, Kanmatsuse K (2003) Visualization of a coronary collateral channels by multislice spiral computed tomography. Heart Vessels 18:163–164

    Article  PubMed  Google Scholar 

  12. Sato Y, Inoue F, Yoshimura A, Fukui T, Imazeki T, Kato M, Ono H, Yoda S, Mitsui M, Matsumoto N, Furuhashi S, Takahashi M, Kanmatsuse K (2003) Regression of an atherosclerotic coronary artery plaque demonstrated by multislice spiral computed tomography in a patient with stable angina pectoris. Heart Vessels 18:224–226

    Article  PubMed  Google Scholar 

  13. Imazeki T, Sato Y, Inoue F, Anazawa T, Tani S, Matsumoto N, Takayama T, Uchiyama T, Saito S (2004) Evaluation of coronary artery remodeling in patients with acute coronary syndrome and stable angina by multislice computed tomography. Circ J 68:1045–1050

    Article  PubMed  Google Scholar 

  14. Sato Y, Matsumoto N, Inoue F, Imazeki T, Kusama J, Tamaki T, Furuhashi S, Takahashi M, Kanamaru H, Karasawa K, Ayusawa M, Harada K, Kanmatsuse K (2004) Assessment of coronary artery abnormalities in a patient with Kawasaki disease by multislice computed tomography. Heart Vessels 19:297–299

    Article  PubMed  Google Scholar 

  15. Said SA, el Gamal MI, van der Werf T (1997) Coronary arteriovenous fistulas: collective review and management of six new cases-changing etiology, presentation, and treatment strategy. Clin Cardiol 20:748–752

    Article  PubMed  CAS  Google Scholar 

  16. Maron BJ (2003) Sudden death in young athletes. N Engl J Med 349:1064–1075

    Article  PubMed  CAS  Google Scholar 

  17. Cheitlin MD, De Castro CM, McAllister HA (1975) Sudden death as a complication of anomalous coronary origin from the anterior sinus of Valsalva: a not-so-minor congenital anomaly. Circulation 50:780–787

    Google Scholar 

  18. Frescura C, Basso C, Thiene G, Corrado D, Pennelli T, Angelini A, Daliento L (1998) Anomalous origin of the coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol 29:689–695

    Article  PubMed  CAS  Google Scholar 

  19. Ness MS, McManus BM (1998) Anomalous right coronary artery origin in otherwise unexplained infant death. Arch Pathol Lab Med 112:626–629

    Google Scholar 

  20. Benge W, Martins JB, Funk DC (1980) Morbidity associated with anomalous origin of the right coronary artery from the left sinus of Valsalva. Am Heart J 99:96–100

    Article  PubMed  CAS  Google Scholar 

  21. Virmani R, Chun PKC, Goldstein RE, Rabinowitz M, McAllister HA (1984) Acute take-off of the coronary arteries along the aortic wall and congenital coronary ostial ridges: association with sudden death. J Am Coll Cardiol 3:766–771

    PubMed  CAS  Google Scholar 

  22. Kaku B, Kanaya H, Ikeda M, Uno Y, Fujita S, Kato F, Oka T (2000) Acute inferior myocardial infarction and coronary artery spasm in a patient with an anomalous origin of the right coronary artery from the left sinus of Valsalva. Jpn Circ J 64:641–643

    Article  PubMed  CAS  Google Scholar 

  23. Ichikawa M, Komatsu S, Asanuma H, Iwata A, Ishiko T, Hirayama A, Lim YJ, Kodama K, Mishima M (2005) Acute myocardial infarction caused by “malignant” anomalous right coronary artery detected by multidetector row computed tomography. Circ J 69:1564–1567

    Article  PubMed  Google Scholar 

  24. Kimbiris D, Abdulmassih SL, Segal BL, Bemis CE (1978) Anomalous origin of coronary arteries. Circulation 58:606–615

    PubMed  CAS  Google Scholar 

  25. Vijayvergiya R, Jaswal RK (2005) Anomalous left anterior descending, absent circumflex and unusual dominant course of right coronary artery: a case report. Int J Cardiol 102:147–148

    Article  PubMed  Google Scholar 

  26. Page HL, Engel HJ, Campbell WB, Thomas CS (1974) Anomalous origin of the left circumflex coronary artery: recognition, angiographic demonstration and clinical significance. Circulation 50:768–773

    PubMed  Google Scholar 

  27. Aydinlar A, Cicek D, Senturk T, Gemici K, Sedar OA, Kazazoglu AR, Kumbay E, Cordan J (2005) Parimary congenital anomalies of the coronary arteries: a coronary arteriographic study in Western Turkey. Int Heart J 46:97–103

    Article  PubMed  Google Scholar 

  28. Taylor AJ, Rogan KM, Virmani R (1992) Sudden cardiac death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol 20:640–647

    PubMed  CAS  Google Scholar 

  29. Barthe JE, Benito M, Sala J, Houbani AJ, Esplugas F, Gausi C (1994) Double right coronary artery. Am J Cardiol 73:622

    Article  PubMed  CAS  Google Scholar 

  30. Aydogdu S, Ozdemir M, Diker E, Korkmaz P, Sozutek Y, Kutuk B (1997) Double right coronary artery: A rare coronary artery anomaly. Acta Cardiol 52:359–361

    PubMed  CAS  Google Scholar 

  31. Altun A, Akdemir O, Erdogan O, Gultac O (2002) An interesting diagnostic dilemma: double right coronary artery or high take off of a large right ventricular branch. Int J Cardiol 82:99–102

    Article  PubMed  Google Scholar 

  32. Harikrishnan S, Bhat A, Tharakan JM (2001) Double right coronary artery. Int J Cardiol 77:315–316

    Article  PubMed  CAS  Google Scholar 

  33. Timurkaynak T, Ciftci H, Cengel A (2002) Double right coronary artery with atherosclerosis: a rare coronary artery anomaly. J Invas Cardiol 14:337–339

    Google Scholar 

  34. Nair K, Krishnamoorthy KM, Tharakan JA (2005) Double right coronary artery with anomalous origin of septal arteries from the right coronary sinus. Int J Cardiol 101:309–310

    Article  PubMed  Google Scholar 

  35. Ozeren A, Aydin M, Bilge M, Dursun A, Onuk T (2005) Atherosclerotic double right coronary artery and ectasia of left coronary arteries in a patient with presented acute coronary syndrome and ventricular tachycardia. Int J Cardiol 102:341–343

    Article  PubMed  Google Scholar 

  36. Egred M, Shakespeare CF, Pennell D, Corr L (2005) Magnetic resonance angiography in the assessment of a first reported case of duplicate right coronary artery. Int J Cardiol 101:329–331

    Article  PubMed  CAS  Google Scholar 

  37. Sari I, Uslu N, Gorgulu S, Nurkalem Z, Eren M (2006) Inferior myocardial infarction and extensive atherosclerosis in a patient with double right coronary artery. Int J Cardiol 111:321–323

    Article  PubMed  Google Scholar 

  38. Lipton MJ, Barry WH, Obrez I, Silverman JF, Wexler L (1979) Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance. Radiology 130:39–47

    PubMed  CAS  Google Scholar 

  39. Turhan H, Duru E, Yetkin E, Atak R, Senen K (2003) Right coronary artery originating from distal left circumflex: an extremely rare variety of single coronary artery. Int J Cardiol 88:309–311

    Article  PubMed  Google Scholar 

  40. Chou LP, Kao C, Lin SL (2004) Right coronary artery originating from distal left circumflex artery in a patient with an unusual type of isolated single coronary artery. Jpn Heart J 45:337–342

    Article  PubMed  Google Scholar 

  41. Kunimasa T, Sato Y, Ito S, Takagi T, Lee T, Saeki F, Moroi M (2007) Absence of the right coronary artery detected by 64-detector-row computed tomography. Int J Cardiol 115:249–250

    Article  PubMed  Google Scholar 

  42. Sato Y, Matsumoto N, Ichikawa M, Nakanishi K, Yoda S, Kunimoto S, Kasamaki Y, Takayama T, Komatsu S, Uchiyama T, Saito S (2006) MDCT detection of congenital absence of the left circumflex artery associated with atherosclerotic coronary artery disease. Int J Cardiol 113:408–409

    Article  PubMed  Google Scholar 

  43. Gupta NC, Beauvais J (1991) Physiologic assessment of coronary artery fistula. Clin Nucl Med 16:40–42

    Article  PubMed  CAS  Google Scholar 

  44. Balanescu S, Sangiorgi G, Castelvecchio S, Medda M, Inglese L (2001) Coronary artery fistulas: clinical consequences and methods of closure: a literature review. Ital Heart J 2:669–676

    PubMed  CAS  Google Scholar 

  45. Velvis H, Schmidt KG, Silverman NH, Turley K (1989) Diagnosis of coronary artery fistula by two-dimensional echocardiography. J Am Coll Cardiol 14:968–976

    Article  PubMed  CAS  Google Scholar 

  46. Krishnamoorthy KM, Rao S (2004) Transesophageal echocardiography for the diagnosis of coronary arteriovenous fistula. Int J Cardiol 96:281–283

    Article  PubMed  CAS  Google Scholar 

  47. Sato Y, Ishikawa K, Sakurai I, Hashimoto M, Ebuchi T, Yoda S, Matsumoto N, Koyama S, Katsumata N, Sugino K, Sakamaki T, Kanmatsuse K (1997) Magnetic resonance imaging in diagnosis of right coronary arteriovenous fistula: A case report. Jpn Circ J 61:1043–1046

    Article  PubMed  CAS  Google Scholar 

  48. Vitarelli A, De Curtis G, Conde Y, Colantonio M, Di Benedetto G, Pecce P, De Nardo L, Squillaci E (2002) Assessment of congenital coronary artery fistulas by transesophageal color Doppler echocardiography. Am J Med 113:127–133

    Article  PubMed  Google Scholar 

  49. Sato Y, Mitsui M, Takahashi H, Miyazawa T, Okabe H, Inoue F, Kusama J, Horie T, Matsumoto N, Hori Y, Furuhashi S, Takahashi M, Kanmatsuse K (2004) A giant left circumflex coronary arteryright atrium arteriovenous fistula detected by multislice spiral computed tomography. Heart Vessels 19:55–56

    Article  PubMed  Google Scholar 

  50. Bland EF, White PD, Garland J (1933) Congenital anomalies of the coronary arteries: report of an unusual case associated with cardiac hypertrophy. Am Heart J 8:787–801

    Article  Google Scholar 

  51. Moodie DS, Fyfe D, Gill CC, Cook SA, Lytle BW, Taylor PC, Fitzgerald R, Sheldon WC (1983) Anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland syndrome) in adult patients: long-term follow-up after surgery. Am Heart J 106:381–383

    Article  PubMed  CAS  Google Scholar 

  52. Ishikawa T, Brandt PW (1985) Anomalous origin of the left main coronary artery from the right anterior aortic sinus: angiographic definition of anomalous course. Am J Cardiol 55:770–776

    Article  PubMed  CAS  Google Scholar 

  53. Sakuma H, Ichikawa Y, Chino S, Hirano T, Makino K, Takeda K (2006) Detection of coronary artery stenosis with whole-heart coronary magnetic resonance angiography. J Am Coll Cardiol 48:1946–1950

    Article  PubMed  Google Scholar 

  54. Sato Y, Matsumoto N, Yoda S, Kunimoto S, Kasamaki Y, Takayama T, Furuhashi S, Takahashi M, Uchiyama T, Saito S (2006) Wholeheart coronary magnetic resonance angiography in a patient with unstable angina. Int J Cardiol 111:309–310

    Article  PubMed  Google Scholar 

  55. Sato Y, Matsumoto N, Saito S (2007) Three-dimensional whole heart magnetic resonance imaging of anomalous origin of the right coronary artery. Heart 93:907

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Cardiovascular Division, Osaka Police Hospital, Osaka, Japan

    Sei Komatsu, Atsushi Hirayama & Kazuhisa Kodama

  2. Department of Cardiology, Nihon University School of Medicine, 1-8-13 Kanda-surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan

    Yuichi Sato, Makoto Ichikawa, Naoya Matsumoto & Tadateru Takayama

  3. Division of Cardiology, Toshiba Hospital, Tokyo, Japan

    Taeko Kunimasa, Shingo Ito, Takuro Takagi, Tetsuo Lee & Satoshi Saito

  4. Cardiovascular Division, Kawachi General Hospital, Higashi-Osaka, Japan

    Miroru Ichikawa & Masayoshi Mishima

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  1. Sei Komatsu
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  2. Yuichi Sato
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  3. Makoto Ichikawa
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  4. Taeko Kunimasa
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Correspondence to Yuichi Sato.

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Komatsu, S., Sato, Y., Ichikawa, M. et al. Anomalous coronary arteries in adults detected by multislice computed tomography: presentation of cases from multicenter registry and review of the literature. Heart Vessels 23, 26–34 (2008). https://doi.org/10.1007/s00380-007-1005-x

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  • DOI: https://doi.org/10.1007/s00380-007-1005-x

Key words

  • Anomalous coronary artery
  • Multislice computed tomography