A study on coronary artery anomalies in adult patients undergoing coronary angiography for various indications

Abstract

Introduction: As variations in coronary artery anatomy is very common, the term “coronary artery anomaly” (CAA) applies only to the rarer forms of anatomic aberrations seen in the general population. CAAs are usually detected incidentally during coronary angiography (CAG) or autopsy. Some hemodynamically significant anomalies cause symptoms at young age and can cause sudden death. Knowledge of CAA is necessary to suspect them in appropriate clinical setting for early diagnosis and management that may be lifesaving. Subjects and Methods: Over a period of 1 year, we studied coronary anatomy of 1000 adult patients attending a tertiary cardiac center for coronary artery disease, valvular heart disease planning valve surgery, etc., where CAG was required. The absolute prevalence of different CAAs was recorded. Results: In our study, 3.6% of the patients had CAA. Most common of them were “right coronary artery arising from the left sinus” and “separate origin of the left anterior descending artery and left circumflex artery from the left sinus.” A significant coronary artery fistula was the next common. Conclusion: Some CAAs made coronary intervention technically challenging. There were hemodynamic implications in some, namely myocardial ischemia resulting from significant myocardial bridge and “coronary steal phenomenon” related to large coronary artery fistula. A high index of suspicion is required for early diagnosis, and the management of most serious forms can abort serious consequences. Information regarding CAAs is also helpful to overcome procedural difficulty during coronary and cardiothoracic interventions and avoid complications.