Advertisement

Coronary Artery Anatomy and Anomalies

  • Adriana D. M. Villa
  • Amedeo Chiribiri
Chapter

Abstract

Congenital coronary artery anomalies are not common, but it is crucial to identify them as in some cases they can cause myocardial ischemia, arrhythmias, and sudden cardiac death. It is also important to identify variants and anomalies without clinical relevance on their own, as complications during surgery or catheter-based interventions can occur. The aim of this chapter is to give a comprehensive and concise overview of coronary embryology and normal coronary artery anatomy, describe common variants of normal anatomy, and summarize typical patterns of anomalous coronary artery anatomy. We described three groups according to their frequency in the general population: normal, normal variant, and anomaly. We have further subdivided the anomalies based on their functional relevance: coronary artery anomalies with obligatory ischemia, without ischemia, or with exceptional ischemia. The chapter is complemented by images taken from invasive coronary angiography, coronary computed tomography, and cardiac magnetic resonance to help illustrate the nature of the anomalies.

References

  1. 1.
    Reese DE, Mikawa T, Bader DM. Development of the coronary vessel system. Circ Res. 2002;91:761–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Young PM, Gerber TC, Williamson EE, Julsrud PR, Herfkens RJ. Cardiac imaging: part 2, normal, variant, and anomalous configurations of the coronary vasculature. Am J Roentgenol. 2012;197:816–26.CrossRefGoogle Scholar
  3. 3.
    Angelini P. Normal and anomalous coronary arteries: definitions and classification. Am Heart J. 1989;117:418.CrossRefPubMedGoogle Scholar
  4. 4.
    Van der Velden LBJ, Bär FWHM, Meursing BTJ, Ophuis TJMO. A rare combination of coronary anomalies. Neth Hear J. 2008;16:387–9.CrossRefGoogle Scholar
  5. 5.
    Goldsmith JB, Butler HW. The development of the cardiac–coronary circulatory system. Am J Anat. 1937;60:185.CrossRefGoogle Scholar
  6. 6.
    Clark EB. Cardiac embryology: its relevance to congenital heart disease. Am J Dis Child. 1986;140:41–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Conte G, Pellegrini A. On the development of the coronary arteries in human embryos, stages 14–19. Anat Embryol. 1984;169:209–18.CrossRefPubMedGoogle Scholar
  8. 8.
    Angelini P. Clinical articles: coronary artery anomalies—current clinical issues: definitions, classification, incidence, clinical relevance, and treatment guidelines. Tex Heart Inst J. 2002;29:271.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Angelini P, Velasco JA, Flamm S. Coronary anomalies incidence, pathophysiology, and clinical relevance. Circulation. 2002;105:2449–54.CrossRefPubMedGoogle Scholar
  10. 10.
    Angelini P. Coronary artery anomalies an entity in search of an identity. Circulation. 2007;115:1296–305.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Raff GL, Abidov A, Achenbach S, Berman DS, Boxt LM, Budoff MJ, Cheng V, Tony D, Hellinger JC, Karlsberg RP. SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr. 2009;3:122–36.CrossRefPubMedGoogle Scholar
  12. 12.
    Menke DM, Waller BF, Pless JE. Hypoplastic coronary arteries and high takeoff position of the right coronary ostium. A fatal combination of congenital coronary artery anomalies in an amateur athlete. Chest. 1985;88:299–301.CrossRefPubMedGoogle Scholar
  13. 13.
    Flessas D, Mamarelis I, Maniatis V. An unusual pattern of three major components of the cardiovascular system: multimodality imaging and review of the literature. J Cardiothorac Surg. 2013;8:61.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Shriki JE, Shinbane JS, Rashid MA, Hindoyan A, Withey JG, DeFrance A, Cunningham M, Oliveira GR, Warren BH, Wilcox A. Identifying, characterizing, and classifying congenital anomalies of the coronary arteries. Radiographics. 2012;32:453–68.CrossRefPubMedGoogle Scholar
  15. 15.
    Apitzsch J, Kühl HP, Muhlenbruch G, Mahnken AH. Unusual malignant coronary artery anomaly: results of coronary angiography, MR imaging, and multislice CT. Cardiovasc Intervent Radiol. 2009;33:389–93.CrossRefPubMedGoogle Scholar
  16. 16.
    Karadag B, Ayan F, Ismailoglu Z, Goksedef D, Ataev Y, Vural VA. An extraordinary cause of ischemic chest pain in a young man: congenital ostial atresia of the right coronary artery. J Cardiol. 2009;54:335–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Chiribiri A, Ishida M, Nagel E, Botnar RM. Coronary imaging with cardiovascular magnetic resonance: current state of the art. Prog Cardiovasc Dis. 2011;54:240–52.CrossRefPubMedGoogle Scholar
  18. 18.
    Boffano C, Chiribiri A, Cesarani F. Native whole-heart coronary imaging for the identification of anomalous origin of the coronary arteries. Int J Cardiol. 2009;137:e27–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Angelini P, Trujillo A, Sawaya F, Lee V-V. “Acute takeoff” of the circumflex artery: a newly recognized coronary anatomic variant with potential clinical consequences. Tex Heart Inst J. 2008;35:28.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Frescura C, Basso C, Thiene G, Corrado D, Pennelli T, Angelini A, Daliento L. 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.CrossRefPubMedGoogle Scholar
  21. 21.
    Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Catheter Cardiovasc Diagn. 1990;21:28–40.CrossRefGoogle Scholar
  22. 22.
    Morales AR, Romanelli R, Tate LG, Boucek RJ, De Marchena E. Intramural left anterior descending coronary artery: significance of the depth of the muscular tunnel. Hum Pathol. 1993;24:693–701.CrossRefPubMedGoogle Scholar
  23. 23.
    Leon F, Salazar H, Moreira W, Angelini P. Daughter, you broke my heart: accidental thrombosis at a muscular bridge. Tex Heart Inst J. 2006;33:380.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Juillière Y, Berder V, Suty-Selton C, Buffet P, Danchin N, Cherrie F. Isolated myocardial bridges with angiographic milking of the left anterior descending coronary artery: a long-term follow-up study. Am Heart J. 1995;129:663–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Konen E, Goitein O, Sternik L, Eshet Y, Shemesh J, Di Segni E. The prevalence and anatomical patterns of intramuscular coronary arteries: a coronary computed tomography angiographic study. J Am Coll Cardiol. 2007;49:587–93.CrossRefPubMedGoogle Scholar
  26. 26.
    De Rosa R, Sacco M, Tedeschi C, Pepe R, Capogrosso P, Montemarano E, Rotondo A, Runza G, Midiri M, Cademartiri F. Prevalence of coronary artery intramyocardial course in a large population of clinical patients detected by multislice computed tomography coronary angiography. Acta Radiol. 2015;49:895–901.CrossRefGoogle Scholar
  27. 27.
    Ferreira AG Jr, Trotter SE, König B Jr, Decourt LV, Fox K, Olsen EG. Myocardial bridges: morphological and functional aspects. Br Heart J. 1991;66:364–7.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Koester MC. A review of sudden cardiac death in young athletes and strategies for preparticipation cardiovascular screening. J Athl Train. 2001;36:197–204.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Yurtdas M, Gülen O. Anomalous origin of the right coronary artery from the left anterior descending artery: review of the literature. Cardiol J. 2012;19:122.CrossRefPubMedGoogle Scholar
  30. 30.
    Sloan K, Majdalany D, Connolly H, Schaff H. Inferior wall myocardial infarction caused by anomalous right coronary artery. Can J Cardiol. 2008;24:S102–3.CrossRefGoogle Scholar
  31. 31.
    Venturini E, Magni L. Single coronary artery from the right sinus of Valsalva. Heart Int. 2011;6:e5.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Basso C, Olivotto I, 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 Coll Cardiol. 2000;35:1493–501.CrossRefPubMedGoogle Scholar
  33. 33.
    Davies JE, Burkhart HM, Dearani JA, Suri RM, Phillips SD, Warnes CA, Sundt TM III, Schaff HV. Surgical management of anomalous aortic origin of a coronary artery. Ann Thorac Surg. 2009;88:844–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Cacici G, Angelini P. Unusual case of single coronary artery: questions of methods and basic concepts. Ital Heart J. 2005;6:345–7.PubMedGoogle Scholar
  35. 35.
    Angelini P, Walmsley RP, Libreros A, Ott DA. Symptomatic anomalous origination of the left coronary artery from the opposite sinus of valsalva: clinical presentations, diagnosis, and surgical repair. Tex Heart Inst J. 2006;33:171–9.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Dodge-Khatami A, Mavroudis C, Backer CL. Congenital heart surgery nomenclature and database project: anomalies of the coronary arteries. Ann Thorac Surg. 2000;69:270–97.CrossRefGoogle Scholar
  37. 37.
    Roberts WC. Major anomalies of coronary arterial origin seen in adulthood. Am Heart J. 1986;111:941–63.CrossRefPubMedGoogle Scholar
  38. 38.
    Peña E, Nguyen ET, Merchant N, Dennie C. ALCAPA syndrome: not just a pediatric disease. Radiographics 2009;29:553–65.CrossRefPubMedGoogle Scholar
  39. 39.
    Alexander RW, Griffith GC. Anomalies of the coronary arteries and their clinical significance. Circulation. 1956;14:800.CrossRefPubMedGoogle Scholar
  40. 40.
    Alexi-Meskishvili V, Nasseri BA, Nordmeyer S, Schmitt B, Weng Y-G, Böttcher W, Hübler M, Berger F, Hetzer R. Repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children. J Thorac Cardiovasc Surg. 2011;142:868–74.CrossRefPubMedGoogle Scholar
  41. 41.
    Baitaxe HA, Wixson D. The incidence of congenital anomalies of the coronary arteries in the adult population 1. Radiology. 1977;122:47–52.CrossRefGoogle Scholar
  42. 42.
    Camarda J, Berger S. Coronary artery abnormalities and sudden cardiac death. Pediatr Cardiol. 2012;33:434–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Frommelt PC, Frommelt MA, Tweddell JS, Jaquiss RD. Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course. J Am Coll Cardiol. 2003;42:148–54.CrossRefPubMedGoogle Scholar
  44. 44.
    Click RL, Holmes DR, Vlietstra RE, Kosinski AS, Kronmal RA. Anomalous coronary arteries: location, degree of atherosclerosis and effect on survival—a report from the Coronary Artery Surgery Study. J Am Coll Cardiol. 1989;13:531–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Bunce NH, Lorenz CH, Keegan J, Lesser J, Reyes EM, Firmin DN, Pennell DJ. Coronary artery anomalies: assessment with free-breathing three-dimensional coronary MR angiography 1. Radiology. 2003;227:201–8.CrossRefPubMedGoogle Scholar
  46. 46.
    Sawaya FJ, Sawaya JI, Angelini P. Split right coronary artery its definition and its territory. Tex Heart Inst J. 2008;35:477.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Gulel O, Yazici M, Durna K, Demircan S. Images in cardiology: a rare coronary anomaly: double right. Clin Cardiol. 2007;30:309.CrossRefPubMedGoogle Scholar
  48. 48.
    Erbagci H, Davutoglu V, Turkmen S, Kizilkan N, Gumusburun E. Double right coronary artery: review of literature. Int J Cardiovasc Imaging. 2006;22:9–11.CrossRefPubMedGoogle Scholar
  49. 49.
    Hongsakul K, Suwannanon R. Congenital absence of left circumflex artery detected by computed tomography coronary angiography: a case report. Case Rep Vasc Med. 2012;2012:1–3.Google Scholar
  50. 50.
    Roberts WC, Glick BN. Congenital hypoplasia of both right and left circumflex coronary arteries. Am J Cardiol. 1992;70:121–3.CrossRefPubMedGoogle Scholar
  51. 51.
    Said SA, Van der Werf T. Dutch survey of congenital coronary artery fistulas in adults: coronary artery–left ventricular multiple micro-fistulas. Int J Cardiol. 2006;110:33–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Kassaian SE, Mahmoodian M, Salarifar M, Alidoosti M, Abbasi SH, Rasekh A. Stent-graft exclusion of multiple symptomatic coronary artery fistulae. Tex Heart Inst J. 2007;34:199.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Int J Cardiovasc Imaging (Internet). 2002;18:539–42. Available from: http://circ.ahajournals.org/cgi/doi/10.1161/hc0402.102975.Google Scholar
  54. 54.
    Clemente A, Del Borrello M, Greco P, Mannella P, Di Gregorio F, Romano S, Morra A. Anomalous origin of the coronary arteries in children: diagnostic role of three-dimensional coronary MR angiography. Clin Imaging. 2010;34:337–43.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Biomedical Engineering and Imaging SciencesKing’s College London, Guy’s and St Thomas’ Hospital NHS Foundation TrustLondonUK

Personalised recommendations