Prevalence and Pattern of Congenital Coronary Artery Anomalies in Patients Undergoing Coronary Angiography at a Tertiary Care Hospital of Northern India.

Jeet Ram Kashyap,Lipi Uppal,Sreenivas Reddy,Vikas Kadiyala,Suraj Kumar,Hithesh Reddy,Raghavendra Rao K,Maninder Kansal,Rashmi Kashyap,Ojasav Sehrawat

doi:10.7759/cureus.14399

Abstract

Objectives: To evaluate the prevalence and pattern of congenital coronary artery anomalies (CAAs) in the adult population undergoing catheter coronary angiography.Methods: The coronary angiograms done between October 2015 and September 2020 were reviewed for the presence of coronary anomalies based upon Angelini's classification. The medical record of patients with anomalies was reviewed for symptomatology and indication of angiography.Results: CAAs were found in 129 (87 males and 42 females) of 6,258 patients giving a prevalence of 2.06%. The mean age was 57.8 ± 11.8 (range 32-81) years. Among these, the anomalous origin and course of the coronaries were the most common anomaly seen in 81 (1.29%) patients, followed by intrinsic anomalies of the coronary arterial system in 44 (0.7%) patients and anomalies of coronary termination and anomalous anastomotic vessels in 2 (0.03%) patients each. Overall, the absence of the left main trunk with a separate origin of the left anterior descending (LAD) and the circumflex artery was the commonest anomaly seen in 46 (0.74%) patients, followed by dual LAD in 35 (0.56%) patients. The anomalous origin of the right coronary artery (RCA) from the left sinus was seen in 14 patients (0.22%) and that of the circumflex artery from the right sinus or right coronary artery was seen in 11 patients (0.17%). The origin of the left main and RCA from ascending aorta was found in eight (0.13%) patients. One (0.02%) patient had a single coronary artery, and another one (0.02%) had all the three coronary arteries arising from the right sinus; however, with separate ostia. The split RCA was seen in nine (0.14%) patients and there were two (0.03%) patients each of coronary artery fistulae, and of anomalous anastomotic vessels.Conclusions: The prevalence of congenital coronary anomalies in this study was 2.06%. The commonest anomaly was that of origin and courses of the vessels, however, the pattern of anomalies is different from previous studies.

Highlights

Coronary artery anomalies (CAAs) are rare congenital disorders with varied clinical presentations
The commonest anomaly was that of origin and courses of the vessels, the pattern of anomalies is different from previous studies
CAAs are benign in nature and most patients remain asymptomatic, some of these may present with various clinical manifestations like angina, dyspnoea, syncope, acute coronary syndrome, heart failure, ventricular arrhythmias and sudden cardiac death (SCD)

Summary

Introduction

Coronary artery anomalies (CAAs) are rare congenital disorders with varied clinical presentations. Its prevalence among the adult population varies in angiographic and autopsy series and on average is around 1%. CAAs are benign in nature and most patients remain asymptomatic, some of these may present with various clinical manifestations like angina, dyspnoea, syncope, acute coronary syndrome, heart failure, ventricular arrhythmias and sudden cardiac death (SCD). The classification and nomenclature of CAAs have remained inconsistent, the one proposed by Angelini et al is most commonly followed. According to this classification, the nomenclature is followed as (i) normal if a particular pattern is seen in >1% of the general population; (ii) an anomaly, if any pattern is seen in

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