Primary Congenital Coronary Artery Anomalies: An Angiographic Study in Greece

Abstract

Abstract Background: Primary congenital coronary anomalies are anatomical variations of the origin, course and termination of coronary arteries, which are not associated with complex congenital heart disease. In Greece, apart from some case reports, there are no published data. Thus, the aim of this study was to assess the prevalence of the different forms of primary coronary artery anomalies in a Greek adult population. Methods: 5051 coronary arteriographies obtained from January 2008 to December 2010 were retrospectively analyzed. Coronary anomalies were classified according to the criteria proposed by Angelini and coworkers as anomalies of origin and course, anomalies of intrinsic coronary anatomy, and anomalies of termination. Results: 123 variations of coronary artery anatomy (incidence 2.44%) were identified. Of these, 76 (61.8%) patients had anomalous origin and course, 25 (20.3%) patients had ectasias, 14 (11.4%) patients had myocardial bridging, and 8 (6.5%) patients had small coronary fistulas. The most common anomalies observed were the separate origin of the left anterior descending (LAD) and left circumflex (LCx) coronary arteries, the ectopic right coronary artery (RCA) and the anomalous LCx from the opposite sinus. Conclusions: The incidence of primary congenital anomalies in Greece is similar to that reported in other populations. Congenital coronary anomalies do not predispose to accelerated atherosclerosis of the anomalous vessel. Although the majority of coronary anomalies were not associated with symptoms and were detected incedentaly during coronary angiography, awareness of these anatomical variants is clinically important for the appropriate management of cardiac patients.