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Coronary artery anomalies

Part II: Recent insights from clinical investigations

Anomalien der Koronararterien Teil II: Aktuelle Erkenntnisse aus klinischen Untersuchungen

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Zusammenfassung

Angeborene Anomalien der Koronargefäße finden sich in 0,2–1,2% der Bevölkerung. Sie verursachen 12% der mit sportlicher Aktivität assoziierten plötzlichen Todesfälle und 1,2% der nicht im Rahmen sportlicher Aktivitäten auftretenden plötzlichen Todesfälle. Wir bieten eine Übersicht über die Fortschritte, die hinsichtlich der embryologischen Grundlagen dieser Koronaranomalien erzielt wurden und diskutieren neuere Erkenntnisse zu ihrer Diagnostik und Therapie. Der hier vorgelegte zweite Teil unserer Übersicht stellt aktuelle Konzepte zur Definition von koronarer Anomalität dar und informiert über Inzidenz, Verlauf und Prognose einzelner Entitäten. Besonderes Augenmerk richten wir auf die Diskussion von Möglichkeiten zum nicht-invasiven Screening größerer Bevölkerungskollektive und zur invasiven Diagnostik für die Risikostratifikation bei bereits diagnostizierter Koronaranomalie. Hierbei beleuchten wir besonders die klinische Problematik von Anomalien wie dem Abgang einer Koronararterie aus dem gegenüberliegenden Koronarsinus (ACAOS), Koronarfisteln und Myokardbrücken, die nur bei einer kleinen Gruppe von Patienten tatsächlich zu Komplikationen führen. Schließlich stellen wir die aktuellen Empfehlungen zur Diagnostik und Therapie von Koronaranomalien dar.

Summary

Congenital anomalies of the coronary arteries occur in 0.2–1.2% of the general population; they cause 12% of sports-related sudden cardiac deaths and 1.2% of non-sports-related deaths. We review some of the substantial advances that have been made both, in the understanding of the embryonic development of the coronary arteries and in the clinical diagnosis and management of their anomalies. In this second part of our review we elucidate recent approaches to defining coronary anomalies and provide information on their incidence and prognosis. In addition, we discuss the options for screening large populations for potentially lethal coronary malformations and elucidate the role of invasive diagnostic modalities such as intravascular ultrasound, flow wire and pressure wire. The clinical relevance of coronary anomalies is discussed particularly for the ill-defined group of anomalies that only occasionally cause severe clinical events comprising anomalous origination of a coronary artery from the opposite sinus (ACAOS), coronary artery fistulae and myocardial bridging. Finally, we provide an update on current diagnostic and therapeutic recommendations.

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  1. Clinic of Internal Medicine III, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Y. von Kodolitsch,  O. Franzen,  G. K. Lund,  D. H. Koschyk,  W. D. Ito &  T. Meinertz

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  1. Y. von Kodolitsch
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von Kodolitsch, Y., Franzen, O., Lund, G.K. et al. Coronary artery anomalies. ZS Kardiologie 94, 1–13 (2005). https://doi.org/10.1007/s00392-005-0153-1

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