Anomalous Coronary Artery Anatomy Research Articles

Transcatheter aortic valve implantation in patients with anomalous coronary artery.

The aim of this review was to analyze literature and provide systematic algorithm to guide decision making during TAVI procedure. Transcatheter aortic valve implantation (TAVI) is growing in popularity and expanding to younger patients with lower risk profiles. Currently, there is no concise guideline on the management strategy during TAVI in patients with anomalous coronary artery (ACA) anatomy undergoing this procedure. A systematic search was conducted for relevant case reports of TAVI in patients who had confirmed ACA anatomy. Twenty-fourcase reports, that met the criteria for this review, were identified and included in the final study size. TAVI was successful in 23 out of 24 cases. Half of the cases (12) described performing balloon aortic valvuloplasty (BAV) before TAVI. The majority (15) reported using angiogram Postimplantation. Only one-third of cases (8) reported performing coronary protection (with either wire, wire and stent or wire and balloon). Two-third of case reports (16/24, 67%) mentioned using Edwards SAPIEN balloon expandable transcatheter heart valves (THV). Preprocedural diagnostic imaging tests play important role in determining the ACA anatomy and its relation to the aortic valve. BAV with simultaneous coronary arteries angiography or aortography should be performed before implantation of THV, as it could potentially predict whether the ACA would be compressed. Using at least a coronary wire for ACA protection is recommended in case there is high risk of ACA obstruction. Management strategy should be individualized when performing TAVI in patients with ACA.

The influence of coronary artery anatomy on mortality after the arterial switch operation

ObjectiveWe sought to determine the influence of coronary artery anatomy on mortality in more than 1000 children undergoing the arterial switch operation. MethodsAll patients who underwent an arterial switch operation were identified from 2 hospital databases and reviewed retrospectively. Coronary anatomy was recorded from operative reports using the Leiden classification. ResultsAn arterial switch operation was performed in 1033 children between 1983 and 2013. Coronary anatomy was normal in 697 patients (67%). The most common type of anomalous coronary anatomy was the circumflex coronary artery arising from sinus 2 (in 152 patients [15%]). Forty-seven patients (4.5%) had all coronary arteries arising from a single sinus. Of these 47 patients, 34 patients (3.3%) had a true single coronary artery. Fifty-two patients (5.0%) had an intramural coronary artery. Overall early mortality was 3.3% (34 out of 1033 patients) over the 30-year period. Early mortality was 3.0% (21 out of 697) for patients with normal coronary anatomy and 3.9% (13 out of 336) for any type of anomalous coronary anatomy. Early mortality was 3.3% (5 out of 152) for patients with the circumflex coronary artery arising from sinus 2, 6.4% (3 out of 47) for patients with all coronary arteries arising from a single sinus, and 5.9% (2 out of 34) for patients with a true single coronary artery. Early mortality for patients with intramural coronaries was 1.9% (1 out of 52). No coronary pattern was found to be a risk factor for mortality. ConclusionsPatients with anomalous coronary artery anatomy had higher rates of early mortality after the arterial switch operation but this was not statistically significant. Coronary artery reoperations were rare.

Evaluation of non-ECG and ECG-gated computed tomographic angiography for three-dimensional printing of anomalous coronary arteries in dogs with pulmonic stenosis

Introduction/objectivesCoronary artery abnormalities are described sporadically in dogs, most commonly with pulmonic stenosis. Computed tomographic angiography (CTA) allows non-invasive assessment of coronary anatomy. Three-dimensional (3D) models improve the understanding and visualization of spatially complex anatomy. The study objective was to evaluate coronary artery anomalies using CTA imaging and using rapid prototyping technology to create life-sized coronary artery models of these studies. Animals, material and methodsCombined retrospective case and prospective pilot study. Inclusion criteria were dogs with reported coronary artery anomalies. The CTA data sets were imported into a medical imaging framework for the analysis of the coronary arteries and into a 3D-planning and printing software for creating printable 3D models. The 3D models were printed using fusion deposition modeling technology. ResultsSix male dogs with an R2A coronary artery anomaly and pulmonic stenosis diagnosed by CTA were included. Electrocardiogram (ECG)-gated CTA allowed better identification of anomalous coronary arteries than non-gated CTA. In all dogs, the right coronary artery had a smaller diameter than the left and the left coronary artery or its branch had a prepulmonic course. All ECG-gated studies were 3D printed while non-gated studies were not printable due to CTA artifacts. ConclusionIn dogs, CTA is effective for diagnosis of coronary artery anomalies. Printed 3D models of ECG-gated CTA studies were of excellent quality and allowed direct visualization of abnormal coronary artery anatomy. The usefulness of these models to improve the understanding of anomalous coronary artery anatomy could be evaluated in future studies.

Cardiovascular Computed Tomographic Angiography as a Virtual Patient Avatar for Individualized Surgical Planning of Complex Anomalous Coronary Artery Anatomy.

Cardiovascular computed tomographic angiography (CCTA) 3-D thoracic reconstruction can serve as a "virtual patient avatar" providing surgical views for approach to complex anomalous coronary artery anatomy. Images demonstrated a single coronary artery ostium arising from the right aortic sinus with trifurcation into a prepulmonic left anterior descending coronary artery (LAD), an interarterial circumflex with a subsequent intraseptal course, and normal course of the right coronary artery. Virtual 3-D CCTA reconstructions were important to planning an incisional plane for surgical correction.

Anomalous coronary artery anatomy with a single coronary ostium arising from the right coronary: a case report and literature review.

Purpose: This article reports the case of a single coronary artery with origin from a single ostium in the right sinus of Valsalva (RSOV) with an anomalous course of the left coronary artery anterior to the pulmonary trunk.Results: We present the case of an anomalous single coronary artery detected incidentally during routine coronary computed tomography (CT) angiography performed by a multislice CT method, using a 64-detector-row scanner. The CT examination revealed that the patient had a single large right coronary artery arising from the right sinus of Valsalva, dividing into the right coronary artery, left main coronary artery (LMCA), and left circumflex artery (LCX). The LMCA turned anteriorly in front of the pulmonary outflow tract, reaching the atrioventricular groove. The LCX artery passed posterior to the aorta (retro-aortic) and then between the left atrium and left ventricular outflow tract to reach its normal course on the left side.Conclusion: We present a rare case of single coronary artery congenital anomaly from the Makkah region of Saudi Arabia. This kind of coronary artery anomaly in the absence of stenosis could remain silent and asymptomatic.

Coronary artery anomalies in Turner Syndrome

BackgroundCongenital heart disease, primarily involving the left-sided structures, is often seen in patients with Turner Syndrome. Moreover, a few case reports have indicated that coronary anomalies may be more prevalent in Turner Syndrome than in the normal population. We therefore set out to systematically investigate coronary arterial anatomy by computed tomographic coronary angiography (coronary CTA) in Turner Syndrome patients. MethodsFifty consecutive women with Turner Syndrome (mean age 47 years [17–71]) underwent coronary CTA. Patients were compared with 25 gender-matched controls. ResultsCoronary anomaly was more frequent in patients with Turner Syndrome than in healthy controls [20% vs. 4% (p = 0.043)]. Nine out of ten abnormal cases had an anomalous left coronary artery anatomy (absent left main trunk, n = 7; circumflex artery originating from the right aortic sinus, n = 2). One case had a tubular origin of the right coronary artery above the aortic sinus. There was no correlation between the presence of coronary arterial anomalies and karyotype, bicuspid aortic valve, or other congenital heart defects. ConclusionCoronary anomalies are highly prevalent in Turner Syndrome. The left coronary artery is predominantly affected, with an absent left main coronary artery being the most common anomaly. No hemodynamically relevant coronary anomalies were found.

Acute myocardial infarction in a premature infant on the first day of life

Abstract Neonatal myocardial infarction (MI) is a very rare but potentially life-threatening condition with an approximated mortality rate of 80%. Congenital heart disease, anomalous coronary artery anatomy, thromboembolism, coagulopathy, birth asphyxia or myocarditis have been suggested as possible causes of MI. Here we report the case of a premature infant who died at about 40 h of life from a massive MI. Autopsy revealed an occlusive thrombus in the right coronary artery. An isolated prothrombotic status, characterized by a double copy variant of the MTHFR A1298C mutation, was identified at the postmortem genetic studies as a possible explanation for the coronary artery thrombosis. No other risk factors were detected.

Sudden cardiac death while playing Australian Rules football: a retrospective 14year review.

Australian Rules football is a sport which evolved from Gaelic football and which is played by a large number of predominantly male participants in a number of countries. The highest participation rates are in the southern states of Australia. A retrospective review over a period of 14years identified 14 cases of sudden cardiac death that occurred in individuals while playing the sport. All were male and ranged in age from 13 to 36years with a mean and median age of 23years. A spectrum of cardiac causes was identified including coronary artery atherosclerosis, myocarditis, anomalous coronary artery anatomy, arrhythmogenic right ventricular cardiomyopathy, and healed Kawasaki disease. In 5 cases the heart was morphologically normal raising the possibility of a channelopathy. No traumatic deaths were identified. Some of the individuals had experienced symptoms prior to the fatal episode and the role of pre participation screening in reducing mortality is discussed.

Coronary artery anomalies overview: The normal and the abnormal.

The aim of this review is to give a comprehensive and concise overview of coronary embryology and normal coronary anatomy, describe common variants of normal and summarize typical patterns of anomalous coronary artery anatomy. Extensive iconography supports the text, with particular attention to images obtained in vivo using non-invasive imaging. We have divided this article into three groups, according to their frequency in the general population: Normal, normal variant and anomaly. Although congenital coronary artery anomalies are relatively uncommon, they are the second most common cause of sudden cardiac death among young athletes and therefore warrant detailed review. Based on the functional relevance of each abnormality, coronary artery anomalies can be classified as anomalies with obligatory ischemia, without ischemia or with exceptional ischemia. The clinical symptoms may include chest pain, dyspnea, palpitations, syncope, cardiomyopathy, arrhythmia, myocardial infarction and sudden cardiac death. Moreover, it is important to also identify variants and anomalies without clinical relevance in their own right as complications during surgery or angioplasty can occur.

Myocardial Infarction in a Newborn Heterozygous for the MTHFR C677T Mutation

Neonatal myocardial infarction secondary to congenital heart disease, anomalous coronary artery anatomy, thromboembolism, coagulopathy, birth asphyxia, and unknown causes has been previously reported. We now report an infant who suffered a massive myocardial infarction during birth, requiring extensive resuscitation and aggressive management. A thrombus, the origin of which was not detected on autopsy, was found occluding the proximal left coronary artery several hours after birth. Genetic studies revealed a single copy variant of the MTHFR C677T mutation that we speculate may have predisposed the infant to coronary thrombosis.

An unexpected cause of angina detected by ECG-gated cardiac computed tomography

Until recently anomalous coronary artery anatomy was only identified either by coronary angiography, at autopsy, or during cardiac surgery. With recent developments in the area of cardiac imaging, ECG-gated cardiac computed tomography (CT) has emerged as a minimally invasive modality to delineate both coronary anatomy and pathology. We present a case of an anomalous right coronary artery origin from the ascending aorta detected by ECG-gated cardiac CT in a 47 year-old male who presented to the emergency department complaining of acute chest pain after intense exercise. Given its relatively non invasive nature, ECG-gated cardiac CT may assist in the diagnosis and management of patients with atypical chest pain in which more invasive diagnostic examinations (i.e. coronary angiography) are not warranted.

Repair of Tetralogy of Fallot with Anomalous Coronary Arteries Coursing Across the Obstructed Right Ventricular Outflow Tract

Anomalous coronary artery (ACA) anatomy occurs in 2-9% of patients with tetralogy of Fallot (TOF), in which the left anterior descending coronary artery (LAD) originates from the right coronary artery (RCA) crossing the right ventricular outflow tract. The purpose of this study was to review our results of repair for TOF with ACA. Between 1978 and 2001, 43 ACA patients (mean age, 4.8 years; range, 5 months-41 years) underwent repair for TC. The ACA anatomy was classified as the single LAD from the RCA (n = 20), a significant conal branch (dual LAD) from the RCA (n = 13), paired anterior descending arteries originating from the left and right coronary arteries (n = 7), and single RCA from the LAD (n = 3). In cases in which the anomalous LAD crossed the obstructed infundibulum, thinning or coring of the endocardium was done. Patch infundibuloplasty was performed in 39 patients, with 10 needing separate RV and pulmonary artery patches, and the pulmonary valve was preserved. Nine patients had the addition of a monocusp to a transannular incision. Two patients had a main pulmonary arterioplasty alone. There was one early (2.3%) and no late deaths. Mean early and late postoperative gradients were 21.5 +/- 10.5 mmHg (4 patients had > or =30 mmHg) and 27.1 +/- 13.7 mmHg (5 patients had >30 mmHg; p = 0.12), respectively. There were four reoperations during a mean follow-up of 4.8 years (range, 6 months to 18 years). Actuarial freedom from reoperation was 90% at 5, 10, and 15 years. At the latest follow-up, all patients were in NYHA functional class I. TOF repair for an ACA can be performed without disturbing the native coronary anatomy and without the use of conduits in most cases. Outcomes are similar to those of other patients with TOF. The presence of ACA does not impose increased risk after this surgical strategy.

Syncope in the Hospital

A case is presented in which a man with anomalous coronary artery anatomy and thrombotic oronary stenoses had an episode of syncope. Further subsequent presyncopal events coincided with ventricular tachycardia on ambulatory ECG; stenting of the lesions eliminated further symptoms. The importance of seeking prognostically significant cardiac causes of syncope is discussed.

Pulmonary artery translocation: a surgical option for complex anomalous coronary artery anatomy

Rather than perform a difficult and potentially high risk coronary reimplantation in a patient with an aberrant right coronary artery coursing between the aorta and pulmonary artery, the main pulmonary artery was translocated toward the left pulmonary hilum to create additional space between the aortic and pulmonic trunks.

Transaortic Approach in Double-Outlet Right Ventricle With Subaortic Ventricular Septal Defect

The standard approach (right ventriculotomy and atriotomy) for surgical repair of double-outlet right ventricle with subaortic ventricular septal defect and pulmonary stenosis may not give an adequate view of the intracardiac defect due to the presence of anomalous coronary artery anatomy or unusual cavity spacial relationship. Thus, a transverse aortotomy was performed and the left ventricular outflow tract was well visualized through the aortic valve and could be reconstructed precisely. Therefore, the transaortic approach also should be considered for systemic route reconstruction in this group.

Recent advances in cardiac magnetic resonance imaging.

Magnetic resonance imaging of the cardiovascular system is now a well-recognized primary investigative technique for many conditions of structural abnormality in clinical cardiology, but the assessment of functional abnormality is also valuable and is increasingly being recognized by clinicians because of the accuracy and reproducibility of the techniques. Recently, focus has centered on reduction of motion artifact and scan time by rapid imaging techniques and on applications in coronary artery disease. Magnetic resonance coronary angiography can be used reliably to assess coronary artery bypass graft patency and anomalous coronary artery anatomy, and techniques of assessing native coronary artery stenosis and flow are close to being clinically useful. Advances continue in the assessment of myocardial perfusion, right and left ventricular function, and myocardial metabolism. With this combination of anatomic and functional information, magnetic resonance imaging will play an ever-increasing role in the assessment of cardiac disease.