Congenital coronary artery anomalies

Abstract

Abstract Congenital coronary artery anomalies are abnormalities in the origin, course or structure of these arteries, and their incidence varies from 0.2% to 5.6%. Although the majority of anomalies are asymptomatic, they are the second most common cause of sudden cardiac death in young athletes. The aim of this study is to highlight the main anomalies with hemodynamic significance, particularly anomalous aortic origin of coronary arteries and anomalous left coronary artery from the pulmonary artery. Anomalous aortic origins of coronary arteries account for 14–17% of all sudden cardiac deaths that unexpectedly occur in healthy children or young athletes during or immediately after physical exercise. The mechanism responsible for the compression/occlusion of the coronary artery originating from the opposite sinus is still unclear and several mechanisms have been proposed. The clinical presentation of these patients varies and physical examination is normal in most cases. Transthoracic echocardiography is the most commonly used test for diagnosis. The treatment, management and follow-up of these patients are the subject of debate. The anomalous origin of the left coronary artery arising from the pulmonary artery is an even rarer condition and, without corrective surgery, most patients die within the first year of life. Echocardiography is also the method of choice to confirm this condition. The diagnosis of this anomaly in a seriously ill child is an indication for urgent surgery. Due to the hemodynamic abnormalities caused by these abnormalities, early diagnosis and treatment are important.