Congenital abnormalities of the coronary arteries are an uncommon but important cause of chest pain and, in some cases of hemodynamically significant abnormalities, sudden cardiac death. For several decades, premorbid diagnosis of coronary artery anomalies has been made with conventional angiography. However, this imaging technique has limitations due to its projectional and invasive nature. The recent development of electrocardiographically (ECG)-gated multi-detector row computed tomography (CT) allows accurate and noninvasive depiction of coronary artery anomalies of origin, course, and termination. Multi-detector row CT is superior to conventional angiography in delineating the ostial origin and proximal path of an anomalous coronary artery. Familiarity with the CT appearances of various coronary artery anomalies and an understanding of the clinical significance of these anomalies are essential in making a correct diagnosis and planning patient treatment.

https://pubs.rsna.org/doi/pdf/10.1148/rg.262055068

Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation.

The clinical manifestations of coronary artery anomalies vary in severity, with some anomalies causing severe symptoms and cardiovascular sequelae and others being benign. Cardiovascular computed tomography (CT) has emerged as the standard of reference for identification and characterization of coronary artery anomalies. Therefore, it is important for the reader of cardiovascular CT images to be thoroughly familiar with the spectrum of coronary artery anomalies. Hemodynamically significant anomalies include atresia, origin from the pulmonary artery, interarterial course, and congenital fistula. Non-hemodynamically significant anomalies include duplication; high origin; a prepulmonic, transseptal, or retroaortic course; shepherd's crook right coronary artery; and systemic termination. In general, coronary arteries with an interarterial course are associated with an increased risk of sudden cardiac death. Coronary artery anomalies that result in shunting, including congenital fistula and origin from the pulmonary artery, are also commonly symptomatic and may cause steal of blood from the myocardium. Radiologists should be familiar with each specific variant and its specific constellation of potential implications.

Identifying, Characterizing, and Classifying Congenital Anomalies of the Coronary Arteries

Congenital coronary artery anomaly is an uncommon condition. Most of these anomalies are clinically silent without associated myocardial ischemia, but some of those may cause significant myocardial ischemia or infarction. Multidetector computed tomography with electrocardiogram (ECG)-gating has a faster volume coverage and higher spatial and temporal resolution and is a noninvasive and accurate technique that can be used to show these kinds of anomalies. Understanding the computed tomographic findings of various coronary artery anomalies is important for obtaining an accurate diagnosis and for formulating an optimal patient treatment plan.

Coronary Artery Anomalies: Classification and Electrocardiogram-Gated Multidetector Computed Tomographic Findings

Congenital anomalies of the coronary arteries are an uncommon, but important, cause of pain in the chest, myocardial ischaemia and even sudden cardiac death, especially in young individuals. This paper focuses on the surgical treatment of congenital anomalies of the coronary arteries in adults; indications for surgery and the different surgical options will be reviewed.

Surgical management of congenital coronary arterial anomalies in adults

We report a case of Type I dual left anterior descending artery (LAD) successfully treated by coronary artery bypass grafting including the long LAD. This rare coronary artery anomaly is of clinical importance in the field of myocardial revascularization.

Dual left anterior descending coronary artery: report of a case.

Between April 1996 through March 1999, 15 patients with severe (> 60%) left main coronary artery stenosis became hemodynamically unstable on induction of anesthesia, in spite of optimal pharmacological management. Retrograde coronary sinus perfusion was instituted soon after the median sternotomy to improve hemodynamics until the establishment of cardiopulmonary bypass after harvesting internal mammary artery and saphenous vein grafts.

Retrograde Coronary Sinus Perfusion for Severe Left Main Stenosis

Spontaneous dissection of a coronary artery is a rare cause of obstructive coronary artery disease and sudden death. We report a case of spontaneous dissection of the left main coronary artery, whi...

Spontaneous Dissection of Left Main Coronary Artery: Surgical Management

A 70-year-old woman with eventration of the left dome of the diaphragm, presented with features of acute respiratory distress. She was successfully treated by emergency plication of the diaphragm. Computed tomography of the chest was useful for diagnosis.

Surgical Management of Eventration of Diaphragm in an Elderly Patient

Dual left anterior descending artery (or dual anterior interventricular artery) is a rare coronary anomaly. It is important to know the anatomic variants of this anomaly in patients with coronary artery disease who are undergoing either surgical myocardial revascularization or coronary angioplasty.

We report the cases of 4 patients who had anatomic variants of dual left anterior descending coronary artery. These patients had developed coronary artery disease in the long or the short left anterior descending artery, or in both. The long left anterior descending artery was diseased in 1 patient, and the short left anterior descending artery was diseased in another. In the 3rd and 4th patients, both the long and the short arteries were atherosclerotic and had developed severe stenosis.

All 4 patients underwent successful myocardial revascularization. There was no electrocardiographic evidence of perioperative myocardial infarction. All patients were asymptomatic during the follow-up period, which ranged from 3 months to 1.5 years.

Angiographers and surgeons alike must be aware of the variants of dual left anterior descending coronary artery, so that the diseased vessels can be correctly identified even if 1 of the dual arteries is 100% occluded.

Dual left anterior descending coronary artery: surgical revascularization in 4 patients.

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Papers

Retrograde Coronary Sinus Perfusion for Severe Left Main Stenosis

Spontaneous Dissection of Left Main Coronary Artery: Surgical Management

Surgical Management of Eventration of Diaphragm in an Elderly Patient

Dual left anterior descending coronary artery: surgical revascularization in 4 patients.