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.
Similar content being viewed by others
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
References
Angelini P, Velasco JA, Flamm S (2002) Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation 105:2449–2454
Alexander RW, Griffith GC (1956) Anomalies of the coronary arteries and their clinical significance. Circulation 14:800–805
Yamanaka O, Hobbs RE (1990) Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Catheter Cardiovasc Diagn 21:28–40
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 37:593–597
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 42:270–275
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 35:1493–1501
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 133:428–435
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 77:992–995
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 92:986–991
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 29:689–695
Cademartiri F, Casolo G, Midiri M (2008) Clinical applications of cardiac CT. Springer-Verlag, Berlin
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 26:1987–1992
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 29:343–355
Kayalar N, Burkhart HM, Dearani JA, Cetta F, Schaff HV (2009) Congenital coronary anomalies and surgical treatment. Congenit Heart Dis 4:239–251
Samarendra P, Kumari S, Hafeez M et al (2001) Anomalous circumflex coronary artery: benign or predisposed to selective atherosclerosis. Angiology 52:521–526
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 118:2395–2451
Shi H, Aschoff AJ, Brambs HJ, Hoffmann MH (2004) Multislice CT imaging of anomalous coronary arteries. Eur Radiol 12:2172–2181
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 12:2163–2171
Schmitt R, Froehner S, Brunn J et al (2005) Congenital anomalies of the coronary arteries: imaging with contrast-enhanced, multidetector computed tomography. Eur Radiol 6:1110–1121
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 4:781–791
Jonge GJ, Ooijen PA, Piers LH et al (2008) Visualization of anomalous coronary arteries on dual-source computed tomography. Eur Radiol 11:2425–2432
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 194:1495–1499
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Krupiński, M., Urbańczyk-Zawadzka, M., Laskowicz, B. et al. Anomalous origin of the coronary artery from the wrong coronary sinus evaluated with computed tomography: “High-risk” anatomy and its clinical relevance. Eur Radiol 24, 2353–2359 (2014). https://doi.org/10.1007/s00330-014-3238-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-014-3238-2