Major Primary Congenital Coronary Artery Anomalies: An Angiographic Study

Abstract

Congenital Coronary artery anomalies are found in about 1 % population (0.6% to 1.5% in different geographic studies). Angiographic recognition of these anomalies is important because of their clinical significance (sudden death) and importance in patients undergoing coronary interventions or cardiac surgery. Our study included 3215 patients who underwent diagnostic coronary angiography during the 2 years period from 2008 to 2010. Twenty nine (0.90%) patients (22 male and 7 female) had major congenital coronary anomalies of which twenty seven (93.10%) patients had anomalies of origin and distribution while two (6.89%) had coronary artery fistulae. Right coronary artery was the commonest anomalous vessel, involved in 14 (48.27%) patients. It was originating from the left sinus of Valsalva in 10, from the non-facing aortic sinus in 2 and from left anterior descending artery in 2 patients. Anomalous origin of left circumflex artery was the second commonest anomaly, seen in 10 (34.48%) patients. Anomalous left anterior descending artery was found to be originating from right coronary artery in 2 (6.89%) and anomalous left coronary artery from right coronary artery was seen in one (3.4%) patient. Among patients with coronary fistulae, one (3.4%) had fistulae between the left anterior descending artery and the main pulmonary artery, one (3.4%) between the conal artery and the right atrium. The fistulae in our series were small & without significant shunt circulation. Atherosclerotic plaques in anomalous arteries were seen in only 8 (27.58%) patients, significantly less than the incidence (51.5%) of overall coronary artery disease in 3215 patients studied in this series. In two (6.89%) patients only the anomalous vessels were involved in coronary artery disease. Congenital coronary artery anornalies do not appear to be associated with an increased risk for development of coronary atherosclerosis. Recognition of coronary anomalies is important in patients undergoing coronary angiography, coronary interventions and cardiac surgery. Variations in the frequency of major congenital coronary anomalies may have a genetic background.