Congenital Coronary Anomalies Research Articles

Multiple microvessels extending from the coronary arteries to the left ventricle in a middle aged female presenting with ischaemic chest pain: a case report

Possible ischaemic chest pain presentations are exceedingly common. Angiographic triage of clinical, electrocardiographic or biomarker positive presentations is increasingly feasible with the expansion of cardiac catheterization facilities. This management pattern often extends to problem patients with negative biomarker screens whose symptoms appear unstable. With invasive triage even very rare congenital or developmental coronary anomalies will be more frequently recognized although their relationship to ischaemia can be confounded by association. In this a case we report a woman with widespread direct coro-ventricular micro-channel formation across the heart and an ischaemic presentation, despite angiographically normal epicoronary vessels. This pattern, while very rare, needs to be recognized as one possible phenotype in this very common clinical presentation.

Double left anterior descending artery arising from the left and right coronary arteries: Depiction at multidetector-row computed tomography

Double left anterior descending artery arising from the left and right coronary arteries is an extremely rare congenital coronary anomaly, although it has no clinical significance unless atherosclerotic coronary artery disease superimposes. We describe, for the first time, multidetector-row computed tomographic findings of double left anterior descending artery.

Anomalous origin of the septal perforating artery from the right sinus of Valsalva

The first septal perforating artery can anomalously originate from the aortic root. This finding is rare, benign and usually associated with other congenital coronary anomalies. We describe a patient with an isolated anomaly, a septal perforating artery which originated separately from the right sinus of Valsalva.

Right-sided origin of the left main coronary artery evaluated by cardiac computed tomography angiography

3 A 45-year-old man presented with chest pain in the etting of an intermediate likelihood of coronary artery isease. After a mildly abnormal exercise treadmill test, ardiac computed tomography (CT) was ordered to evaluate is chest pain syndrome and to assess the presence of therosclerosis. On 64-dectector cardiac CT (VCT; General lectric, Milwaukee, WI) a right-sided origin of the left ain coronary artery was incidentally found (Figs. 1 and 2). he left main coronary artery has a malignant interarterial ourse between the aorta and pulmonary artery. The left nterior descending artery, left circumflex artery, and the ight coronary artery had nonobstructive coronary artery isease. The incidence of congenital coronary artery anomalies in dults referred for cardiac catheterization is estimated to be pproximately 1%. A right-sided origin of the left main oronary artery was previously described as a rare congental anomaly (1.3% of overall coronary anomalies). More han 50% of persons with this anomaly suddenly die before

Echocardiographic diagnosis of clinically silent congenital coronary artery anomalies

Background The incidence of congenital coronary anomalies is mainly derived from autopsy series and pre-participation exams in athletes. Limited data exist regarding the spectrum of coronary anomalies that can be detected in asymptomatic patients. We sought to describe echocardiographically detected congenital coronary artery anomalies in asymptomatic children after implementing a screening protocol mandating identification of coronary artery origin and proximal course in all initial studies. Methods Our database was searched from 1/1/1993 to 3/31/2006 and all echocardiograms coded for coronary anomalies were identified. Clinically “silent” congenital coronary anomalies were culled from that group. Results Of the 168 “silent” coronary anomalies detected, 111 were anomalies of aortic origin, including 59 patients with “high coronary takeoff” and 30 patients with “wrong sinus” origin of either the left or right coronary artery. Small coronary fistulas were seen in 57. Associated congenital heart defects were found in 53% of individuals with coronary anomalies. Conclusions This study comprises the largest group of echocardiographically detected, “silent” but potentially clinically significant, congenital coronary anomalies in children. Prospective echocardiographic diagnosis of “high coronary takeoff”, a risk factor for injury during cardio-pulmonary bypass, and asymptomatic intraseptal coronary stenosis are described for the first time.

Usefulness of integrated imaging in the diagnosis of a rare coronary artery anomaly in a young athlete

Congenital coronary artery anomalies are a rare cause of major cardiovascular events in adolescents who practise sports activities. Therefore, symptoms suggestive of cardiac ischaemia should always be carefully considered and subjects should undergo a complete cardiovascular assessment. We describe the case of a young non-competitive athlete, referring episodes of exertional chest pain and syncope, in whom multiple imaging techniques allowed the diagnosis of intramural course of the left anterior descending coronary artery.

Congenital coronary arteries anomalies: review of the literature and multidetector computed tomography (MDCT)-appearance

The prevalence of coronary arteries congenital anomalies is 1 to 2% in the general population. Although the spectrum of their clinical manifestations is very broad from total inocuity to lethal, anomalies of coronary arteries need to be recognized by clinicians in certain circumstances: they are the first cause of death in young adults under physical exercise and an abnormal course of a coronary artery can complicate a cardiac surgery. Therefore, a non-invasive test is highly suitable for detecting anomalies of coronary arteries and multidetector computed tomography (MDCT) is likely to be the best one. To understand how anomalies of coronary arteries may occur, we have reviewed the recent literature about their development. Then, the main types of anomalies are presented with their clinical context, and representative MDCT images from our personal database are used for illustration.

Intercoronary Communication Between Left Anterior Descending Artery and Totally Occluded Right Coronary Artery

The author presents a patient with chronic total occlusion of the right coronary artery with a large lumen communication to the distal left anterior descending artery as a single conduit. The diameter of this connection was very large and equaled the distal left anterior descending artery diameter. The unusual finding of a large lumen connection between the left anterior descending artery and right coronary artery most likely represents a congenital coronary anomaly.

A patient with double right coronary artery and acute inferior myocardial infarction due to the critical lesion in one of them

Congenital coronary artery anomalies are detected in approximately 0.6–1.3% of adult patients undergoing coronary arteriography [1]. Most commonly involved is the anomalies of the left coronary system. Double right coronary artery (RCA) is one of the rarest coronary anomaly which was reported twelve times in the literature so far [2–13]. Only three of them were complicated with atherosclerosis and one presented with acute inferior myocardial infarction.

Haemodynamic significance of an anomalous right coronary with inter-arterial course assessed with intracoronary pressure measurements during dobutamine challenge

Autopsy studies have associated congenital coronary anomalies with the risk of sudden cardiac death. However, not all patients with anomalous coronary arteries die suddenly. A means of assessing the potential for ischaemia and thus predicting the risk of sudden death in these patients may be necessary for directing treatment. We present the case of a patient with an anomalous right coronary artery originating from the aortic wall above the left sinus of Valsalva, with an anterior inter-arterial course. The haemodynamic significance of this anomaly was assessed using intracoronary pressure-wire measurements at rest and during dobutamine stress. This technique could be a valid means for assessing stress-induced ischaemia and, therefore, by inference, the risk of sudden cardiac death in these patients.

Computed Tomography Angiography is an Excellent Tool for the Diagnosis of Congenital Coronary Artery Anomalies: A Report of 2 Cases

Congenital coronary artery anomalies are sporadically discovered in patients undergoing coronary angiography and in autopsy series. Although most anomalies are clinically insignificant, some may become causes of cardiovascular morbidities and mortality. Diagnosis is commonly made with conventional coronary artery angiography. The current development of modern cardiac computed tomography allows less invasive imaging of the coronary arteries and might provide additional anatomical and morphological information. Herein, we report our experience with computed tomography coronary angiography, describing 2 clinical cases of patients with symptomatic congenital coronary artery anomalies requiring cardiac surgery.

Recommendations and Considerations Related to Preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update

Sudden deaths of young competitive athletes are tragic events that continue to have a considerable impact on the lay and medical communities.1–17 These deaths are usually due to a variety of unsuspected cardiovascular diseases and have been reported with increasing frequency in both the United States and Europe.1,5 Such deaths often assume a high public profile because of the youth of the victims and the generally held perception that trained athletes constitute the healthiest segment of society, with the deaths of well-known elite athletes often exaggerating this visibility. These counterintuitive events strike to the core of our sensibilities, periodically galvanizing discussion and action, and in the process raise practical and ethical issues related to detection of the responsible cardiovascular conditions. Preparticipation cardiovascular screening is the systematic practice of medically evaluating large, general populations of athletes before participation in sports for the purpose of identifying (or raising suspicion of) abnormalities that could provoke disease progression or sudden death.13,16 Indeed, identification of the relevant diseases may well prevent some instances of sudden death after temporary or permanent withdrawal from sports or targeted treatment interventions.15,17–21 In addition, the increasing awareness that automated external defibrillators (AEDs) may not always prove successful in the secondary prevention of sudden death for athletes with cardiovascular disease22 underscores the importance of preparticipation screening for the prospective identification of at-risk athletes and the prophylactic prevention of cardiac events during sports by selective disqualification. Although some critics have questioned the effectiveness of cardiovascular screening,23,24 overwhelming support for the principle of this public health initiative exists in both the medical and lay communities.13–16,25 The efficacy of the various athlete screening strategies is not easily resolved in the context of evidence-based investigative medicine. Recently, recommendations of the European Society of Cardiology (ESC)16 and International …

Congenital Anomalies of Coronary Artery Origin in Adults: 64-MDCT Appearance

The purpose of this pictorial essay is to review the 64-MDCT appearance of congenital anomalies of the origins of the coronary arteries in adults. Increasing use of MDCT for cardiac imaging of adults requires familiarity with the cross-sectional appearance of congenital coronary artery anomalies visualized with noninvasive imaging techniques. Many of these anomalies are benign, but a small number are associated with myocardial ischemia and sudden death. Increasing use of MDCT in cardiac imaging may yield diagnostic information not obtained with coronary angiography. Axial, multiplanar, and 3D volume-rendered reconstructions should aid in detection and improve interpretation of such anomalies.

Branching Patterns of the Left Main Coronary Artery in the Dog Demonstrated by the Use of Corrosion Casting Technique

As many investigators use dogs as experimental models in catheterization-, ligation-, and collateral flow studies, knowledge and awareness of the canine left coronary artery anatomical variation is vital for differentiation between canine and human coronary arterial patterns and canine and human coronary congenital anomalies with or without circulatory importance. The present study was performed to examine and review the various principal subdivisions of the canine left main coronary artery (LMCA) in vascular casts of 20 hearts obtained from cadavers of clinically normal dogs of various ages, breeds and of either sex. A corrosion casting technique using an acrylic resin called Tensol Cement No. 70 and a lower-viscosity acrylic resin called Mercox were used to produce a three-dimensional model of the canine coronary arteries. In our study, all dog hearts were left preponderant and the patterns of the principal subdivisions of the LMCA were grouped into three types: Type 1 occurred in seven of the 20 dogs (35%), Type 2 in 12 of 20 dogs (60%) and Type 3 in one instance (5%). A comparison between the canine divisional patterns of the LMCA in the vascular casts and those reported in the literature showed major agreement.

La muerte súbita en el deporte. Registro en el Estado español

Introduction and objectives The present article investigates the causes of sudden death in Spain. The data were drawn from the National Registry of Accidental and Sudden Death in Athletes. Methods There were 180 cases of sudden death from 1995 to present. Results 180 cases of sudden death, 166 in males, 12 in females and 4 in which gender was not recorded. Sports: football (40 cases), cycling (39), athletics (24), futsal and racquet sports (8 each) and physical education (7). The most common cases of sudden death were atheromatous coronary disease (48 cases), arrhythmogenic cardiomyopathy (11), hypertrophic cardiomyopathy (9), congenital coronary anomalies (5), idiopathic left ventricular hypertrophy (4), and aortic valvular stenosis (4). In persons aged more than 30 years old (96): atheromatous coronary disease (73.43%), arrhythmogenic cardiomyopathy (6.25%) and hypertrophic cardiomyopathy (4.68%). In deaths occurring in persons aged 30 years or less (84): arrhythmogenic cardiomyopathy (13.72%), hypertrophic cardiomyopathy (11.76%), congenital coronary anomalies (9.8%), idiopathic left ventricular hypertrophy (7.84%), and aortic valvular stenosis (5.88%). In this age group, most deaths were of undetermined cause (27.45%). Conclusions It is difficult to obtain complete data on cases of sudden death in Spanish athletes, the incidence of which is considerable in young persons and adults in the fifth decade of life. The most commonly involved sports are football, cycling and athletics. After the age of 30 years, the most frequent cause of sudden death is atheromatous coronary disease. Below the age of 30 years, the cause with the greatest incidence is unexplained death occurring in a structurally normal heart. Mechanisms for obtaining more detailed information on the causes of sudden death in athletes should be established through this register.

Causes of sudden cardiac death in athletes

Sudden cardiac death in athletes is a growing problem, despite the huge existing knowledge in medicine and sports. In response to vigorous physical activity, the body undergoes profound morphologic and functional changes. These changes are usually healthy, but sometimes may gravitate to some cardiac diseases. But still, most saudden cardiac deaths are due to previous unknown diseases. The most common cause of sudden cardiac death in athletes is hypertrophic cardiomyopathy. Other reasons are congenital coronary artery anomalies, nivocarditis, dilatative cardiomyopathy, arrhythmogenic cardiomyopathy of the right ventricle, sarcoidosis, mitral valve prolapse, aortic valve stenosis, atherosclerosis, long QT syndrome, and blunt impact to the chest. Bearing in mind the above mentioned, more frequent physical examinations of athletes are recommended.

Primary angioplasty with DES-supported culottes stenting to revascularizing a dual left anterior descending coronary artery

Dual left anterior descending coronary artery (Dual LAD) is a quite rare coronary anomaly that can be discovered in about 1% of patients undergoing coronary angiography with normal hearts [ [1] Rigatelli G. Rigatelli G. Congenital coronary artery anomalies in the adult: a new practical viewpoint. Clin Cardiol. 2005; 28: 61-65 Crossref PubMed Scopus (12) Google Scholar ]. Although anomalies associated with the origin, course, branching pattern, and distribution of the coronary arteries have been described in autopsy specimens, these findings have become more relevant since the widespread application of coronary percutaneous revascularization for atherosclerotic coronary artery disease. Usually these kind of coronary anomalies, which can be differentiated in 4 types depending on the origin of major septal and diagonal branches and course within the anterior interventricular sulcus [ [2] Sajja L.R. Farooqi A. Shaik M.S. Yarlagadda R.B. Baruah D.K. Pothineni R.B. Dual left anterior descending coronary artery: surgical revascularization in 4 patients. Tex Heart Inst J. 2000; 27: 292-296 PubMed Google Scholar ], has no clinical consequences but it may be difficult to choose the correct strategy to revascularize this anomaly when both vessels are severely diseased [ 3 Oral D. Berkalp B. Pamir G. Omurlu K. Erol C. Significance of dual left anterior descending coronary artery in interventional cardiology. A case report. Angiology. 1996; 47: 825-829 Crossref PubMed Scopus (9) Google Scholar , 4 Rigatelli G. Franco G. Gemelli M. et al. Recurrent unstable angina after revascularization in a case of dual left anterior descending coronary artery without risk factors: casualness or destiny?. Int J Cardiol. 2004; 97: 133-134 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar ], especially in emergent settings.

Exercise and the Risk of Sudden Cardiac Death

Sports activity may precipitate acute fatalities in both adults and young competitive athletes with concealed heart diseases. However, the risk-benefit ratio of physical exercise differs among these two age groups. In adolescents and young adults, competitive physical exercise is associated with a significant increase of the risk of sudden death. Sports is not "per se" cause of the enhanced mortality in this age group; rather, it acts as a trigger of cardiac arrest in those athletes who are affected by silent cardiovascular conditions, mostly cardiomyopathy, premature coronary artery disease and congenital coronary anomalies, which predispose to life-threatening ventricular arrhythmias during physical exercise. In adults, on the other hand, physical activity can be regarded as a "two-edged sword": vigorous exertion increases the incidence of acute coronary events in individuals who did not exercise regularly, whereas habitual physical activity reduces the overall risk of myocardial infarction and sudden coronary death by preventing development of coronary artery disease and progression of coronary atherosclerotic lesions.

Percutaneous coronary angioplasty in a patient with anomalous single coronary artery arising from the right sinus of Valsalva

We describe a 74-year-old female patient with unstable angina. The coronary angiogram showed the presence of a single coronary artery arising from the right sinus of Valsalva, which is a very uncommon congenital anomaly, with subocclusive atherosclerotic plaques at the proximal and distal right coronary artery. The stenoses were treated through percutaneous coronary angioplasty and insertion of taxol-eluting stents, with complete relief of symptoms and without evidence of myocardial ischemia at 6-months follow up. Single coronary artery is a rare congenital coronary anomaly, which may be asymptomatic and occasionally detected in patients with myocardial ischemia due to atherosclerotic coronary artery disease. In these cases, percutaneous coronary angioplasty with stent insertion may be a successful therapeutic option; however, accurate morphologic identification of anomalous arteries is mandatory before planning these interventions, in order to recognize other possible mechanisms of myocardial ischemia (e.g. vascular compression) and to choose the most appropriate type of pharmacological, percutaneous or surgical intervention.

Does sports activity enhance the risk of sudden cardiac death?

Vigorous physical exercise may precipitate acute fatalities in both adults and young competitive athletes with concealed heart diseases. However, the risk-benefit ratio of physical exercise differs among these two age groups. In adults, physical activity can be regarded as a 'double-edged sword': vigorous exertion increases the incidence of acute coronary events in individuals who did not exercise regularly, whereas habitual physical activity reduces the overall risk of myocardial infarction and sudden coronary death by preventing development and progression of atherosclerotic coronary artery disease. On the other hand, in adolescents and young adults sports activity is associated with a significant increase of the risk of sudden death. Sport is not per se the cause of the enhanced mortality in this age group; rather, it acts as a trigger of cardiac arrest in those athletes who are affected by silent cardiovascular conditions, mainly cardiomyopathy, premature coronary artery disease and congenital coronary anomalies, which predispose to life-threatening ventricular arrhythmias during physical exercise.