Benign Coronary Anomaly Research Articles

P1487 Anomalous right coronary artery from mid left anterior descending artery

Abstract 55-year-old male with history of transient ischaemic attack, excised gastro-intestinal stromal tumour, and osteoarthritis presented to rapid access chest pain clinic with history of atypical chest pain. There were no resting electrocardiographic changes. In accordance with NICE stable chest pain guidelines, a CT coronary angiogram was requested to further assess for any underlying coronary artery disease. This showed normal origin of left main stem (LMS) from left coronary sinus of aorta, however there was an anomalous origin of the right coronary artery (RCA) as a branch from the mid portion of left anterior descending artery (LAD). This was deemed to be an incidental finding with a benign course and not the cause of his symptoms. Coronary anomalies have a reported incidence of 1.3% at invasive coronary angiography (1), and a reported incidence of 0.014-0.066% of single coronary artery (2). Anomalous RCA usually courses from the LMS and courses between the aorta and pulmonary artery. We present an extremely rare variant of single coronary artery arising from the mid LAD without any associated congenital or structural abnormality, on CT coronary angiography (the gold standard for demonstrating coronary anatomy). This is rarely reported in the literature and is a benign coronary anomaly. Abstract P1487 Figure.

An unusual etiology of ischemic stroke: Woven coronary artery anomaly

Woven coronary artery is extremely rare and is still not a clearly defined coronary anomaly in which epicardial coronary artery is divided into multiple thin channels at any segment of the coronary artery, and subsequently, these multiple channels merge again in a normal conduit. The described cases were usually incidentally detected and were considered a benign pathology. But, malignant cases with developing complications such as ischemia, infarction, and arrhythmia are increasing in the literature. In this report, we present a young man with a woven right coronary artery associated with a silent myocardial infarction, inferobasal segment acinesia, an area of scarring, and cardioembolic stroke thought from the scar area. Although it is reported as a benign coronary anomaly in the literature, we should be careful especially in terms of the complications that it causes.

Mechanical extraction of a massive intracoronary thrombus from the super-dominant right coronary artery in thrombogenic lung cancer patient.

The congenital absence of the left circumflex artery and a compensatory super-dominant right coronary artery (RCA) is a very rare benign coronary anomaly in the clinic. The presence of a massive thrombus in the super-dominant RCA can lead to fatal results in cases of acute myocardial infarction, unless the thrombus is mechanically removed. Aspiration of the thrombus using a 6 Fr right Judkins guide catheter is useful to extract a massive thrombus and is both safe and effective. We report a case of complete revascularization of the super-dominant RCA after thrombus aspiration using a 6 Fr Judkins right catheter in a patient with acute inferior and inferolateral wall myocardial infarction.

MicroRNA expression profile in myocardial bridging patients

Background. Myocardial bridging (MB), a common benign coronary anomaly, may bring about some unwanted complications such as angina-like chest pain. The only way of MB detection is coronary arteriography or coronary computed tomographic angiography, which is costly and invasive. This study intended to profile a panel of circulating microRNAs (miRNAs) as potential biomarkers for the diagnosis of MB. Methods. Using TaqMan Low-Density Array followed by quantitative reverse transcriptase PCR (qRT-PCR) validation, we analyzed the expression of miRNAs in serum samples from 90 MB patients and 50 non-MB controls. Results. The Low-Density Array data showed that 196 miRNAs were differentially expressed in MB patient sera in comparison with controls. After qRT-PCR validation and receiver operating characteristic (ROC) analysis, a list of five miRNAs (miR-29b, miR-151-3p, miR-126, miR-503-3p and miR-645) showed the ability to distinguish MB patients from controls. The area under curve (AUC) values range from 0.722–0.938. Conclusions. We have demonstrated that this panel of five serum miRNAs is expected to become potential non-invasive biomarkers for detection of MB.

High-take-off coronary artery: a haemodynamically minor, but surgically important coronary anomaly

Sir, In the pictorial essay published in March 2009, Goo et al. [1] shared their comprehensive experience in identifying coronary artery anomalies in patients with congenital heart diseases using current multislice CT techniques. The authors showed us that haemodynamically benign anomalies may have clinical significance. For example, in patients with high-take-off coronary artery, reckless aortic clamping during cardiopulmonary bypass may reduce coronary artery flow. In our hospital, high-take-off of coronary artery is considered to be the most-easily-overlooked surgically important coronary anomaly. We would like to share our experience to emphasize the importance of this to readers. A 7-year-old boy was diagnosed with polysplenia syndrome and levotransposition of the great arteries, double outlet right ventricle, pulmonary stenosis, bilateral superior vena cava and interrupted inferior vena cava with azygous continuation after birth. Due to progressive symptoms of poor exercise tolerance and cyanosis, he was admitted for bidirectional Glenn shunt. Before surgery, MDCT was arranged. MDCT not only confirmed the diagnosis, but also revealed high-take-off of the left anterior descending coronary artery that was positioned beside the main pulmonary artery and passed anterior to the right ventricular outflow tract (Fig. 1). Since high-take-off of a coronary artery is a haemodynamically benign coronary anomaly and usually considered a normal variant [2], the operator focused on the major cardiac structures during operation. After cavopulmonary anastomoses, while attempting to close the main pulmonary artery stump, the dissection procedure resulted in transection of the left anterior descending coronary artery. In order to preserve left ventricular anterior wall perfusion, emergency coronary artery bypass graft surgery was performed using the right internal mammary artery to anastomose the middle left anterior descending coronary artery. Fortunately, the operation ran smoothly, and the patient was discharged uneventfully. No wall motion impairment was identified on follow-up echocardiography. This case highlights that high-take-off of coronary artery, considered to be a minor coronary anomaly or normal variant [2], can have critical surgical importance. The surgical implications of coronary artery anomalies can be different in different operations. For example, if the patient underwent a Blalock-Taussig shunt, the high take-off would not be a problem. We suggest that cardiac surgeons should review the high-resolution axial, coronal and sagittal thinsection images that are provided by ECG-gated MDCT [3] to simulate the surgical procedure before congenital heart operation to avoid coronary artery injury. W.-L. Tsai : I.-C. Tsai (*) Department of Radiology, Taichung Veterans General Hospital, No. 160, Section 3, Taichung Harbor Road, Taichung 407, Taiwan e-mail: sillyduck.radiology@gmail.com

Newer concepts for imaging anomalous aortic origin of the coronary arteries in adults

Of the different kinds of coronary anomalies observed in adults, anomalous origin of a coronary artery from the opposite sinus of Valsalva with an "interarterial" course (ACAOS) entails a high risk of clinical consequences related to the intramural course of the ectopic coronary artery. We review current imaging modalities for differentiating this condition from generally benign coronary anomalies and for quantifying the severity of individual cases. For identifying ACAOS, noninvasive modalities (echocardiography, computed tomographic angiography, and coronary magnetic resonance angiography) are preferred: the favored modalities are transthoracic echocardiography in children and multidetector computed tomography in adults. For evaluating the pathophysiologic mechanisms of ischemia in ACAOS and subclassifying the severity of individual forms, coronary intravascular ultrasonography provides enhanced temporal and spatial resolution. The critical quantifiable features of the coronary anatomy in ACAOS seem to be hypoplasia, lateral compression at the level of the intramural course, and possibly exercise-related further narrowing of the proximal ectopic segment. Definitive guidelines are being developed for the optimal workup and treatment of ACAOS.

Clinical Significance of Isolated Coronary Bridges

Myocardial bridging of a coronary artery has been noted in 0.5% to 1.6% of arteriograms but the clinical significance is controversial. We reviewed retrospectively 761 consecutive coronary arteriograms performed in the Chinese PLA General Hospital from 1986 to 1996. Myocardial bridging of a coronary artery was noted in 12 cases (1.5%), located exclusively in the left anterior descending coronary artery and isolated without fixed coronary artery stenosis. The bridges ranged in length from 10 to 50mm (mean 24 mm) and were classified as grade 1 (8% of cases), grade 2 (25%) and grade 3 (67%). All patients were hospitalized because of angina. Eight (67%) of the 12 patients suffered from anterioapical dyskinesia including 2 who had acute myocardial infarction with a left ventricular aneurysm. Three patients (25%) with a small posterior descending coronary artery died. In our view, when there is a hyperdominant left anterior descending coronary artery with a small posterior descending artery and a myocardial bridge, the patient appears to be in jeopardy and myocardial bridging can no longer be considered a benign coronary anomaly, especially when there is grade 3 narrowing of the left anterior descending coronary artery during systole.