Common Coronary Anomaly Research Articles

Prevalence, characteristics and significance of anomalous coronary arteries in adults undergoing cardiac CT scans

Abstract Background/introduction The widespread use of CT coronary angiogram (CTCA) for the evaluation of patients with suspected coronary artery disease has resulted in increased identification of anomalous coronary arteries. These are often incidental findings and their prevalence and significance remains unknown. Purpose To identify the prevalence, characteristics and significance of anomalous coronary arteries in patient undergoing cardiac CT for suspected coronary artery disease. Methods This is a retrospective analysis of all cardiac CT scans (n= 5727 CTCAs) performed at two tertiary centres in the UK from 2015 to 2022. For the purpose of this study, we excluded separate LAD and circumflex artery coronary origins given it is clinical non-significance. Results Eighty three patients (1.45%) were identified as having anomalous coronary arteries. The average age of patients with anomalous coronary arteries was 57 years (range 18 - 86 years) and 36% were female. The most common coronary anomaly was the left circumflex artery arising from the right side (49 patients, 59%) and all had a retroaortic course. This was followed by an anomalous right coronary artery arising from the left side (29 patients, 35%) with 93% of them taking an interarterial course whilst 7% had a subpulmonic course. We also identified an anomalous left main stem (14 patients, 17%) arising from the right side (5 retroaortic, 5 subpulmonic, 2 prepulmonic, 1 anterior and 1 interarterial course). Four patients (5%) had an anomalous LAD arising from the right (2 prepulmonic, 1 subpulmonic and 1 anterior course). Four patients had other coronary anomalies (left circumflex artery arising from right pulmonary artery, OM arising from left ventricle, congenital atresia of left main stem and an ALCAPA). Majority of the patients with an anomalous coronary artery taking an interarterial course underwent a stress test. During a mean follow-up period of 4 years, four patients (5%) underwent cardiac surgery for treatment of anomalous coronary artery (ALCAPA, left main stem atresia and two anomalous right with interarterial course), seven patients underwent cardiac surgery for other reasons (significant atherosclerotic coronary artery disease and/or valve disease), five patients underwent PCI for treatment of atherosclerotic coronary artery disease and two patients died for reasons unrelated to their coronary anomaly. Conclusion This study of a large and unselected cohort of CTCA patients demonstrates an overall prevalence of coronary artery anomalies (as defined above) of 1.45%. We also report the prevalence and characteristics of different coronary anomalies and their outcomes. In the majority of patients, coronary artery anomalies are incidental findings and can be managed conservatively.

Coronary Artery Bypass Surgery to Treat Anomalous Origin of Coronary Arteries in Adults: A Systematic Review

To review the available literature on the use of coronary artery bypass grafting (CABG) as a treatment option for anomalous origin of coronary artery in adults. A systematic literature search was performed in March 2023 (including Ovid MEDLINE, Ovid Embase, and the Cochrane Library databases) to identify studies reporting the use of CABG in adult patients with anomalous origin of coronary artery. A total of 31 studies and 62 patients were included, 32 patients (52%) were women, and the mean age was 45.1±16.1 years. The most common coronary anomaly was the right coronary artery arising from the left coronary sinus in 26 patients (42%), followed by an anomalous left coronary artery from the pulmonary artery in 23 patients (37%). A total of 65 conduits were used in 61 patients, and 1 case report did not report conduit type. Reported grafts included saphenous vein (23 of 65 [35.4%]), left internal thoracic artery (15 of 65 [23.1%]), right internal thoracic artery (23 of 65 [35.4%]), and radial artery (2 of 65 [3.1%]); right gastroepiploic artery and basilic vein were used once (1.5%) each. Ligation of the native coronary artery was performed in 42 (67.7%) patients. Patient follow-up was available in 19 studies with a mean of 31.2 months. Only 1 operative mortality was reported. Based on the limited available data, CABG can be performed with good early results. Use of arterial conduits and ligation of the native coronary artery may improve long-term graft patency.

Transposition of the great arteries: single center experiences

Objectives: Transposition of great arteries is the most common cyanotic congenital heart disease. It is characterized by ventriculoarterial discordance and atrioventricular concordance. The aim of the present study was to review the anatomical and embryological basis of this anomaly and to discuss the surgical outcomes of arterial switch operations. Methods: The study included a total of 61 patients who underwent arterial switch operation. Demographic, anatomical, operative data, duration of stay in intensive care unit, need of postoperative extra corporeal membrane oxigenator, need of delayed sternal closure and mortality rate were retrieved from the institutional databases and medical records. Results: The median age of the patients was 22.9±61.26 (1–455) days, and their weights ranged between 3391.97±686.6 (1900–5500) grams. Transposition of great arteries accompanied intact ventricular septum in 39 patients (63.9%) and ventricular septal defect in 22 patients (36.1%). Coronary arteries were abnormal in 11 patients (18%). Mortality was observed in 7 patients (11.5%) and was seen 5.71±2.98 (1–10) days after surgery. The incidence of coronary anomaly in patients with mortality was 28.6%. The most common coronary anomaly in patients with coronary anomaly with mortality is the anomaly in which the circumflex artery originates from the right coronary artery. Conclusion: Arterial switch operations provide anatomical and complete correction in transposition of great arteries. It can be performed with appropriate timing, good preoperative, peroperative and postoperative management with low mortality. Coronary artery anomaly is not a contraindication for arterial switch operations, and with the detailed and careful evaluation of the appropriate coronary artery anatomy, transpositions with coronary anomalies are often uneventful.

Abstract 14138: “RAC”ing up the Coronaries: An Underrecognized Echocardiographic Sign

Background: Both the retro-aortic anomalous coronary (RAC) and bleb signs are underrecognized echocardiographic findings suggestive of an anomalous left circumflex (LCx) coursing posterior to the aortic root. We present a patient in whom these echocardiographic signs were identified and confirmed on additional imaging. Case Presentation: A 77-year-old male presented with heart failure secondary to severe MR. In the apical 4 chamber (A4C) view, tilting anterior demonstrated the RAC sign, a highly echogenic tubular structure in the retro-aortic region above the mitral valve (panel A). In the parasternal long-axis view, the bleb sign, a round structure next to the aorto-mitral curtain, was identified (panel B). The RAC sign was also seen in the short-axis (SAX) as a tunnel-shaped structure behind the aortic root. This structure also represents an orthogonal view of the “bleb sign” (panel C). An anomalous LCx was suspected and was confirmed on both CTA and coronary angiography (panel D). The patient underwent successful mitral valve replacement. Discussion: The most common coronary anomaly is a LCx artery arising from the right sinus of Valsalva. Traditionally, either coronary angiography or CTA, has been required for diagnosis; however, these tests are expensive and invasive. The bleb and RAC signs must be differentiated from other more common echocardiographic findings. In the A4C view, the RAC sign can be mistaken for the coronary sinus, which is typically a more posterior structure, or for calcifications of the aortic valve, which would move with the valve and would not have internal anechoic components. The bleb sign can be differentiated from an abscess of the mitral-aortic fibrosa by identifying the tubular retro-aortic appearance of the structure in the SAX view. Conclusion: The RAC and bleb signs offer a noninvasive means identifying an anomalous LCx; however, they must be differentiated from other cardiac structures which can mimic their appearance.

An unusual congenital coronary anomaly: A circumflex coronary artery arising in ``shotgun`` with the right coronary artery in anterior ST – elevation myocardial infarction

Objective: Coronary anomalies do not generate symptoms, it is incidental findings when performing a coronary angiography in a patient with ischemic heart disease or valvular heart disease. The anomalous origin of the circumflex (LCX) of the right coronary artery (RCA) is one of the common anomalies. We describe a case of CX orifice arising from right coronary sinus in a ``shotgun`` manner with orifice of RCA and successful percutaneous coronary intervention (PCI). Case Report: In this case, the anomalous incidental finding was the arising of the CX artery in “shotgun” shape with the RCA (separate ostium) in a clinic scenario of anterior ST-segment elevation myocardial infarction wherein the patient received fibrinolytic therapy with alteplase, presenting reperfusion criteria (&qt;50% ST-segment resolution at 60 minutes and relief angina) and then underwent to successful PCI. Conclusion: The ectopic origin of the CX is a well-recognized variant, which is considered the most common coronary anomaly. Although this anomaly is classified as benign and asymptomatic, a few cases of sudden death, myocardial infarction, and angina pectoris in the absence of atherosclerotic lesion have been reported. We shared successful PCI in such coronary anomaly in a patients with ST elevation anterior myocardial infarction. Such coronary anomalies should be considered as well in patients with STEMI undergoing PCI.

Coronary anomalies associated with ventricular septal defect.

Coronary anomalies encompass different conditions in terms of anomalous origin, coursing, and branching, which are occasionally associated with congenital heart disease. This study aimed to explore coronary anomalies associated with ventricular septal defect that was a stereotypical congenital heart disease. We retrospectively reviewed angiographic findings in patients with ventricular septal defect who required corrective surgery, and identified coronary abnormalities, including anomalous origin, coursing, and branching of coronary arteries based on angiography. We studied the prevalence and types of coronary anomalies among them. A total of 998 patients with ventricular septal defect was studied. Age and weight were 2.0 (2.1-15.2) months and 5.7 (4.1-8.7) kg, respectively. There were 115 patients (12%) with syndrome or genetic disorder, and 34 patients (3%) with extracardiac major organ anomalies. The overall prevalence of coronary anomalies was 6.2%. All coronary anomalies were anomalous origin and coursing, among 3 patients accompanied anomalous intrinsic coronary anatomy. Originating within aortic root above the Valsalva sinus was the most common coronary anomaly. Coronary anomalies were independently correlated with bicuspid aortic valve (odds ratio [OR]: 8.02, 95% confidence interval [CI]: 2.34-23.4) and persistent left superior caval vein (OR: 5.02, 95% CI: 1.93-11.7). We showed the possibility that minor cardiac variants, such as bicuspid aortic valve and persistent left superior caval vein, contribute to higher prevalence of coronary anomalies in patients with ventricular septal defect.

Clinical and Paraclinical Characteristics of Patients With Coronary Artery Anomalies

Abstract Introduction Coronary artery anomalies are rare congenital abnormalities often found incidentally on conventional coronary angio-gram or coronary computed tomography angiography. They may result in various clinical outcomes. The objective of this study was to investigate the prevalence of coronary artery anomalies, the clinical and laboratory characteristics of patients with coronary artery anomalies, and the outcomes at five-year follow-up of these patients in a high-volume coronary interventional center in Romania. Materials and Methods To define the study population we reviewed all coronary angiograms performed between 01.01.2014 and 31.12.2014. A total number of 5832 coronary angiograms were analyzed, and we identified 31 patients with coronary artery anomalies. Results The prevalence of coronary artery anomalies was 0.53%. Eighty-seven point four percent of the patients had origin and distribution anomalies, and twelve point nine percent of the patients had a coronary artery fistula. The most common coronary artery anomalies were the anomalous origin of the right coronary artery and the anomalous origin of the left circumflex artery from the initial segment of the right coronary artery. Sixty-one point three percent of the patients underwent coronary angiogram due to atypical chest pain. Twenty-nine percent of the patients had significant coronary artery disease. No death or significant complication were recorded in the 31 patients during the 5 years follow-up. Conclusions The prevalence of coronary artery anomalies in this study was slightly lower but still like that of previous studies. The majority of patients presented with atypical symptoms, and only a minority had coronary artery disease. In the context of no death or significant complication at 5-year follow-up highlights the benign prognosis of most coronary artery anomalies.

Myocardial bridges (tunnel coronary arteries) – from understanding of the pathophysiology to the treatment strategy

Myocardial bridges (MB) are the most common congenital coronary anomaly which are characterized by the passage of a segment of the coronary artery in the thickness, but not on the surface of the myocardium as usually. The proximal segment of the left anterior descending artery (LAD) is the most commonly involved vessel in MB. The prevalence of MB is less than 5% when assessed by coronary angiography, but this finding is much more common at autopsy and can occur in almost 30% - 80% of adults. MB is usually a benign condition and often accidental detection in coronary angiography, but under certain conditions can also lead to arrhythmia, acute coronary syndromes, ischemia or myocardial infarction, and even to sudden cardiac death. The article presents brief data on the prevalence, clinic, pathophysiology, diagnosis, treatment of patients with myocardial bridges.

Coronary Artery Anomalies: Echocardiographic Evaluation

Congenital coronary artery anomalies occur either in isolation or in association with other congenital heart disease. With the advent of multimodality imaging, the number of incidentally detected anomalies of coronary origin has risen over the last decade. The clinical presentation of these anomalies can range from being asymptomatic to serious morbidity and mortality, including sudden cardiac death in children and adolescents. We review the most common coronary anomalies and various echocardiographic views used to image the coronary arteries origin, size, and flow.

Incidence, Characteristics and Atherosclerotic Involvement of Coronary Artery Anomalies in Adult Population Undergoing Catheter Coronary Angiography.

BackgroundCoronary artery anomalies (CAAs) are rare disorders of coronary anatomy with varied clinical presentations. There are widespread geographic variations in incidence and patterns of these anomalies, with limited data from North Indian population. We performed a retrospective study to evaluate the incidence, characteristics and atherosclerotic involvement of CAAs in adult population undergoing catheter coronary angiography.MethodsSerial coronary angiographies performed at our institution over a period of 2.5 years (from January 2017 to June 2019) were retrospectively analyzed. We identified patients with anomalous coronaries and studied their clinical characteristics and angiographic profiles.ResultsAmong 3,233 coronary angiograms analyzed, CAAs were found in 99 patients with an incidence of 3.06%. Mean age of the patients was 56.2 ± 12.9 years (range: 20 - 86 years), with 74.75% being males and 25.25% females. Split right coronary artery (RCA) was the most common coronary anomaly, being seen in 27 patients; with an angiographic incidence of 0.84%. Dual left anterior descending artery (LAD) was the second most common anomaly and was seen in 22 cases with an angiographic incidence of 0.68%. Absent left main trunk was noted in 14 patients (0.43%). Ectopic origin of RCA from left sinus was seen in 12 patients (0.37%), while ectopic origin of RCA from ascending aorta was seen in four patients (0.12%). Ectopic origin of left circumflex artery (LCX) from right sinus or RCA was noted in 13 patients (0.40%). One patient (0.03%) had a superdominant LAD supplying the posterior descending artery (PDA). Coronary artery fistulae were seen in six patients (0.18%). Significant coronary artery disease (CAD) was seen in 89 of 268 (33.21%) normal vessels, whereas it was seen in 56 of 114 (49.12%) of anomalous vessels. This difference was statistically significant (P = 0.003).ConclusionsThe incidence of CAAs in our study was slightly higher than many of the previous angiographic series. The patterns of coronary anomalies in our study were different from most of the previous studies. Our study had higher incidence of atherosclerotic involvement of anomalous vessels as compared to normal vessels.

Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management.

Coronary artery fistulas (CAFs) are abnormal communications of coronary arteries whereby venous circuits bypass the normal capillaries within the myocardium. CAFs are rare, and most affected patients are asymptomatic. However, these fistulas are the most common coronary artery anomalies that can alter coronary hemodynamic parameters. Although most CAFs are asymptomatic in young patients, symptoms and complications become more frequent with increasing age. CAFs are characterized by variable clinical manifestations that are based on the size, origin, and drainage site of the fistula. In symptomatic cases, surgical ligation or percutaneous transcatheter closure is often recommended. Although CAFs historically have been evaluated with conventional invasive angiography, electrocardiographically gated cardiac computed tomographic (CT) angiography has emerged as the noninvasive alternative modality of choice owing to the high spatial and temporal resolution and short acquisition time. Furthermore, three-dimensional volume-rendered CT angiograms facilitate accurate assessment of the complex anatomy of CAFs, including their origin, drainage site, and complexity and the number and size of fistulous tracts. Knowledge of these characteristics is crucial for therapeutic planning. Radiologists must be aware of the pathophysiology, clinical manifestations, and characteristic CT angiographic findings of CAFs; appropriate CT angiographic protocols for evaluation of various CAFs; and the role of CT angiography in preprocedural planning and follow-up. Online supplemental material is available for this article. ©RSNA, 2018.

ANGIOGRAPHIC STUDY OF ANATOMICAL VARIATIONS OF CORONARY ARTERIES BY USING DIAGNOSTIC CATHETER

The coronary arteries may present several anomalies, in terms of both number and position. New image-based diagnostic techniques have led to greater reliability in the identification of these anomalies.Aim of the work:this work is done to study the angiographic pattern of normal coronary arteries variations by using the diagnostic catheter.Material and Methods: Any patient enlisted for angiography in catheterization lab in Zagazig University Hospital was enrolled in this study.Results: Data of 4246 patients who underwent coronary angiography were analysed. 115 patients who had anomalous of coronary arteries were entered into final data analysis.The following data could be concluded: The overall incidence of primary congenital coronary anomalies was 2.7% (115 out of 4,246 patients) in our angiographic population, of whom 86 were males (74.7%) and 29 were females (25.3%). The mean age was (45.95 ± 11.65) years. Anomalous LCX was the most common coronary anomaly being present in 35 patients (0.82%) . The second most common anomaly was myocardial bridge and it was present in 31 patients (0.73%). Anomalous RCA was present in eighteen patients (15.65%). Left main coronary artery was absent in two cases (1.7%) and it has anomalous origin from right coronary sinus (RCS) in another two cases (1.7%). On the other hand, anomalous LAD was present in 8 patients (6.95 %). Coronary aneurysms were observed in 10 cases (7.82%). On the other hand, coronary fistulas were diagnosed in nine cases (8.7%). The incidence of coronary anomalies among cases with coronary artery detected disease was 72.2% (83 cases) while this incidence among those without angiographically detected coronary artery disease was 27.8% (32 cases). Hence, the frequency of coronary artery anomaly was significantly higher among patients with CAD than those without CAD ( P < 0.0001). Conclusion:Coronary artery anomaly is a common anomaly between the populations. It could be the only cause of chest pain without significant coronary lesion.

What is the optimal treatment for symptomatic patients with isolated coronary myocardial bridge? A systematic review and pooled analysis.

Myocardial bridging is a common coronary anomaly, with few severe adverse events but a relevant symptom burden. Myocardial bridging treatment, however, remains uncertain because of the lack of randomized trials. MEDLINE/PubMed was systematically screened for studies reporting on isolated myocardial bridging diagnosed at coronary angiography or with coronary computed tomography in patients admitted for suspected angina or with an acute coronary syndrome. Baseline, treatment and outcome data were appraised and pooled according to treatment (medical therapy, bypass surgery/myotomy or stenting). A total of 899 patients in 18 studies were included with a low prevalence of traditional risk factors, especially diabetes (15.6%, interquartile range 2.5-21.5). After a median of 31.0 months (interquartile range 12.4-37.1), major cardiovascular events (composite of death, myocardial infarction or target vessel revascularization) occurred in only 3.4% of the study patients and 78.7% [70.5-86.9; 95% confidence intervals (CI)] were managed conservatively and free of symptoms. When an invasive strategy was planned, freedom from angina was higher in patients treated with surgery [84.5% (78.4-90.7; 95% CI)] than in those treated with stenting [54.7% (38.9-70.6; 95% CI)]. Patients in the stenting group experienced a high incidence of major cardiovascular events related to target vessel revascularization [40.07% (19.83-60.32; 95% CI)]. Meta-regression showed that patients treated with beta-blockers or with a history of hypertension were more likely to remain free from angina (B -0.6, P = 0.013; B -0.66, P = 0.006). Patients with symptomatic isolated myocardial bridging generally have a good long-term prognosis. Pharmacological treatment alone, especially with beta-blockers, is able to improve angina in most cases. Surgical treatment appears to be more effective than stenting in nonresponders.

Coronary artery anomalies in North Indian population: a conventional coronary angiographic study

Abstract Background: Anomalies of origin and course of one or both coronary arteries, with or without symptoms, are of special interest for anatomists, interventional cardiologists, and cardiac surgeons. Aims: To estimate the prevalence of coronary anomalies and their clinical aspects in North Indian population. Material and Methods: Study was done on patients undergoing coronary angiography for suspected coronary artery disease or for coronary intervention at a tertiary care centre in North India. Results: A total of 1130 patients [803 males, 327 females and mean age 57.37°10.60 years] were reviewed for coronary artery anomalies. Overall incidence of Coronary artery anomalies was 13 [1.15%] and was 1% in men and 1.53% in women. 38.46% of these patients were found to have ectopic origin of left circumflex [LCx] and in 23.08% of cases, ectopic origin of right coronary artery [RCA] was noted. Separate orifice for left anterior descending [LAD] and LCx in left coronary sinus [LCS] was observed in 0.27% cases, coronary artery fistula [CAF] in 0.09% cases and single coronary artery from LCS was found in 0.09% cases. Conclusions: The most common coronary anomalies were origin of LCx from RCA and presence of separate orifice for LAD and LCx in LCS. Dominance, gender and coronary artery disease [CAD] have no association with coronary anomalies.

PP-173 [AJC » Percutaneous coronary interventions] Twin Circumflex Arteries: A Rare Coronary Artery Anomaly

Circumflex artery originating from an ostium apart from the left main artery is one of the most common coronary artery anomalies. However dual origin of the circumflex artery is an extremely rare anomaly. We reported a case of twin circumflex arteries one from left main and the other from the proximal right coronary artery.

Coronary artery anomalies in North Indian population : a conventional coronary angiographic study

Background: Anomalies of origin and course of one or both coronary arteries, with or without symptoms, are of special interest for anatomists, interventional cardiologists, and cardiac surgeons. Aims: To estimate the prevalence of coronary anomalies and their clinical aspects in North Indian population. Material and Methods: Study was done on patients undergoing coronary angiography for suspected coronary artery disease or for coronary intervention at a tertiary care centre in North India. Results: A total of 1130 patients [803 males, 327 females and mean age 57.37±10.60 years] were reviewed for coronary artery anomalies. Overall incidence of Coronary artery anomalies was 13 [1.15%] and was 1 % in men and 1.53% in women. 38.46% of these patients were found to have ectopic origin of left circumflex [LCx] and in 23.08% of cases, ectopic origin of right coronary artery [RCA] was noted. Separate orifice for left anterior descending [LAD] and LCx in left coronary sinus [LCS] was observed in 0.27% cases, coronary artery fistula [CAF] in 0.09% cases and single coronary artery from LCS was found in 0.09% cases. Conclusions: The most common coronary anomalies were origin of LCx from RCA and presence of separate orifice for LAD and LCx in LCS. Dominance, gender and coronary artery disease [CAD] have no association with coronary anomalies.

Anomalous Left Coronary Artery from the Pulmonary Artery - Single Center Experience of Sixteen Years

Objectives: Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare but the most common congenital coronary anomaly. The mortality is extremely high without surgical treatment. We analyzed the surgical results and the long term outcome of patients with ALCAPA between 1996 and 2014 in a single center.

Anomalies origin of the right coronary artery from the left coronary sinus and coursing between the pulmonary artery and aorta associated with mitral stenosis

Introduction: coronary arteries anomalies are congenital. Usually, they are asymptomatic. they are found during the coronary angiography or computed tomography angiography. the most common coronary anomaly is separated origin of left anterior descending coronary artery and left circumflex artery coronary artery. Usually, it is a benign anomaly. case report: A 54-year-old male was admitted at the service of cardiology. twenty-five years ago he was diagnosed with mitral stenosis and five years ago as having a thrombotic cerebrovascular accident. Electrocardiogram showed atrial fibrillation trans-thoracic echocardiography showed calcified mitral stenosis, with an anatomical area of 1.1 cm 2 . the patient was treated with oral anticoagulants (acenocumarol), beta-blockers (atenolol), and diuretics (hydrochlorothiazide plus spironolactone). the patient underwent coronary angiography which showed a 75% stenosis of the right coronary artery. the origin and course of right coronary artery was abnormal and thus a ct angiography was performed. the ct angiography confirmed that the origin of the right coronary artery was

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.

Twin Circumflex Artery: a rare coronary artery anomaly

A circumflex coronary artery anomalously originating from the right sinus of Valsalva is the most common coronary anomaly; however dual origin of the circumflex artery is a rare anomaly. We describe here the report of 'twin' circumflex arteries with the anomalous circumflex coronary artery arising from the right coronary sinus and a circumflex artery from left coronary artery.Keywords: Coronary artery anomalies, twin circumflex arteries, right sinus of valsalva