Course Of Anomalous Coronary Artery Research Articles

A clinical case of the retroaortal course of the circumflex artery from the right coronary artery

An anomalous course of coronary arteries is fairly rare pathology, which, however, may underlie clinical manifestations of coronary artery disease. Expanding the possibilities of diagnostic coronary angiography makes it possible to detect numerous types of congenital anomalies of the coronary arteries.However, if earlier they were considered as angiographic findings and were characterized as benign, now this attitude has been changed due to reports of cases of syncope, angina pectoris, and sudden cardiac death associated with their presence. In this regard, a trend emerged to consider such anomalies as “potentially malignant”, which explains special caution at their detection. The article presents a clinical case of an anomalous retroaortic course of the circumflex artery from the right coronary artery.

Diagnosis and demonstration of single coronary artery by multidetector CT angiography: series of two cases

BackgroundSingle coronary artery (SCA) is a rare anomaly, usually diagnosed incidentally during coronary artery angiogram. Individuals with this anomaly mostly remain asymptomatic while some present with symptoms such as chest pain, dyspnoea and even sudden death. The origin and the proximal course of anomalous coronary artery are the main prognostic factors. Several classification systems have been proposed based on the site of origin and anatomical distribution of anomalous artery. Coronary computed tomography angiography has become the reference method for such an assessment noninvasively. Herein, we report a series of two cases of SCA diagnosed on CT angiography. In one case it was single left coronary artery associated with other congenital cardiac anomalies, whereas in other it was single right coronary artery and was an isolated anomaly.Case presentationOur first case was of a 19-year-old female who presented with chest pain and dyspnoea. Transthoracic Echocardiography (TTE) features were suggestive of Tetralogy of Fallot (TOF) with infective endocarditis. Cardiac CT angiography revealed the presence of a large SCA arising from left aortic sinus with absence of normal origin of right coronary artery (RCA). This artery was dividing into and supplying different coronary arterial territories with pre-pulmonic course of RCA. The patient underwent Aortic valve replacement with pulmonary Commissurotomy and improved in post-operative period. Our second case was of a 50-year-old man with complaints of breathlessness and normal ECG and Echocardiography examination findings. Coronary CT angiography revealed the presence of SCA arising from right aortic sinus and supplying the territories of both RCA and Left coronary artery (LCA). The patient was managed conservatively with emphasis on aggressive control of risk factors.ConclusionsSCA is a rare anomaly and may lead to catastrophic life threatening complications. The accurate delineation of the origin and course of the anomalous vessel is of paramount importance while planning surgical intervention. Management usually involves a multi-disciplinary approach with cardiologists and cardiac surgeons aiming for deciding an individual plan based on presentation and anatomy of each case.

Evaluation of Anomalous Coronary Arteries on 64 Slice Multidetector Computerized Tomographic Angiography

Introduction: Anomalous Coronary arteries is a well-known congenital entity with variable effects. The majority of such patients are asymptomatic but some can have adverse effects like ischemia and arrhythmia. Its association with Sudden Cardiac Death in young is established.
 Objective: To determine the frequency of ACA on MDCT in patients referred for coronary artery disease assessment and to determine the origin, course, and morphological variable of SCD of ACA on MDCT.
 Materials and Methods: The study was done in the Department of Cardiovascular Imaging at the Punjab Institute of Cardiology. A retrospective data of patients undergoing CTA for CAD between a period of Jan 2009 and Dec 2017 were analyzed for the presence of Anomalous Coronary Artery (ACA). All patients having anomalous origin from opposite coronary cusp and its course were included. The patients with myocardial bridging and coronary artery fistula were excluded.
 Results: Total patients analyzed with MDCT for CAD and graft assessment between Jan 2009 and December 2017 were 8028. Fifty-three patients were excluded because of poor image quality. Among these ACA were found in 166 (2.08%). Gender distributions were 126 (75.9%) males and 40 (24.09%) females, the mean age in years was 49.31 ± 13.23. The most common ACA was Right coronary artery 83 followed by Left Circumflex 44 (26.50%), Left Anterior Descending Artery 22 (13.25%), and Left Main Stem 17 (10.24%) respectively. Fifty-three (31.92%) patients had previously unknown ACA and were found to have ACA on MDCT and 82 (49.39%) patients were referred following ICA for the confirmation of ACA. The Inter-arterial course was predominant in RCA and Left Coronary Artery 97% and 77% respectively. A retro artic course was predominant (100%) in LCx. Seven patients had associated cyanotic heart disease with ACA. Two patients(one LAD and one RCA) had origin from the Main Pulmonary artery.
 Conclusion: MDCT is the imaging modality of choice for the evaluation of ACA. It can identify the origin of ACA from opposite coronary cusp and defines the malignant course of ACA for the potential risk of sudden cardiac death.

Utility of CT Angiography for the Prediction of Coronary Artery Compression in Patients Undergoing Transcatheter Pulmonary Valve Replacement.

We aimed to evaluate the utility of computed tomography angiography (CTA) for coronary compression (CC) prediction in patients with congenital heart disease undergoing balloon-expandable transcatheter pulmonary valve replacement (TPVR). Coronary compression is a serious complication of TPVR, but the value of preprocedural CTAs to assess CC risk is largely unexplored. In all, 586 patients underwent TPVR between January 2009 and July 2018. Adults with a pre-TPVR CTA and children with a CTA performed less than one year prior to TPVR were included. Patients with poor CTA image quality or with aborted cases due to reasons other than CC were excluded. Sixty-six patients were finally included. Cardiac anatomy was assessed via multiplanar reconstruction of CTAs. Coronary compression occurred in 9 (14%) of the 66 patients who underwent TPVR. Most CC cases (seven of nine) occurred in patients with conduits. Proximity of the right ventricular outflow tract (RVOT) landing zone to the coronary arteries and to the chest wall was a significant risk factor for compression (P < .001 and P = .019, respectively). Compression risk increased significantly if patients had an RVOT to coronary artery distance of ≤3 mm (P < .001) and an RVOT to chest wall distance of ≤8 mm (P = .026). Anomalous course of coronary arteries was another significant univariate risk factor (P = .003). Right ventricular outflow tract landing zone distance of ≤3 mm to a coronary artery, landing zone distance of ≤8 mm to the chest wall, and anomalous coronary arteries are associated with increased CC risk. Electrocardiogram gating may not be necessary if coronary arteries are opacified on CTAs. Larger studies are needed to explore and confirm these coronary artery compression risk factors.

La mort par infarctus du myocarde chez le sujet jeune : étude de 312 cas de mort subite

Sudden cardiac death in young is seen as a dramatic phenomenon requiring knowledge of its impact. We aim to study the epidemiological characteristics of sudden cardiac ischemic death in young, and to discuss his involvement in the occurrence of death. We performed a retrospective cohort study using autopsy data from the department of forensic medicine of the University Hospital of Fattouma Bourguiba, Monastir-Tunisia. A review of all autopsies performed during 23 years was done. In each case, clinical information and circumstances of death were obtained. We have included all sudden death in persons aged between 1 year and 35 years for the male and from one year to 45 years for female. We collected 312 cases of sudden death during the studied period. The collected data were processed using SPSS 20. The significance level was set at 0.05. Thirty-two cases of cardiac ischemic sudden death have been collected. Myocardial infarction was the second cause of sudden death in young patients. There was a male predominance. The most affected subjects were aged between 25–45 years. The death occurred more frequently at rest. Coronary artery disease has been discovered in twenty-four cases (75%). The myocardial infarction occurred on healthy coronary arteries in eight cases. An anomalous course of coronary arteries, in particular myocardial bridging, was found in eight cases (25%). Toxicological screening was negative in all cases. Identifying epidemiological characteristics of sudden cardiac ischemic death in this population is important for guiding approaches to prevention that must be based on dietary hygienic measures and the control of cardiovascular risk factors.

Coronary anomalies: what the radiologist should know.

Coronary anomalies comprise a diverse group of malformations, some of them asymptomatic with a benign course, and the others related to symptoms as chest pain and sudden death. Such anomalies may be classified as follows: 1) anomalies of origination and course; 2) anomalies of intrinsic coronary arterial anatomy; 3) anomalies of coronary termination. The origin and the proximal course of anomalous coronary arteries are the main prognostic factors, and interarterial course or a coronary artery is considered to be malignant due its association with increased risk of sudden death. Coronary computed tomography angiography has become the reference method for such an assessment as it detects not only anomalies in origination of these arteries, but also its course in relation to other mediastinal structures, which plays a relevant role in the definition of the therapeutic management. Finally, it is essential for radiologists to recognize and characterize such anomalies.

OP-248 The Incidence of Coronary Artery Anomalies and Myocardial Bridge in Our Coronary Angiography Series

The American Journal of Cardiology MARCH 13e16, 2014 10 IN AND C The incidence of the coronary artery anomalies ranges between 0.3-1%. Although coronary artery anomalies are present at birth, relatively few of them become symptomatic during childhood. The majority of anomalies are identified as incidental findings during coronary arteriography or at autopsy. However, some may become evident with angina pectoris, myocardial infarction, syncope, cardiac arrhythmias, congestive heart failure and even, sudden death. In this study, rate and pattern of congenital coronary artery anomalies in adult patients undergoing coronary angiography (CA) in a high volume tertiary medical center were reported. Among the 52 887 coronary angiographies performed between 2003 and 2009. 555 (390 male, 165 female) cases of coronary artery anomalies (1.05%) were identified. The mean age of patients with coronary artery anomaly was 52 13 years. Detailed description of coronary artery anomalies in our CA series is presented in Table 1. Atherosclerotic coronary artery disease accompanied to congenital coronary anomaly in (47.6 %) of cases. Myocardial bridges were the most common coronary artery anomaly and detected in 297 (53.5 %) patients. In 195 of cases (35%) anomalous origin or anomalous course of coronary arteries was present. Among them, anomalous origin of circumflex artery from the right coronary sinus was the most common form (n1⁄486, 15.5% of all cases). The second most common pattern regarding anomalous origin was the origin of right coronary artery from the left coronary sinus (n1⁄434, 6.1% of all cases). The rate of separate ostia of the left circumflex and left anterior descending coronary arteries from left coronary sinus or in other words, absence of left main coronary artery in our series was 2.5 % (n1⁄414). Although the absence of left main coronary artery is thought to be higher, this anomaly might not be specified by operator due to its benign course or inadequate imaging during procedure. Coronary artery fistulae were detected in 57 (10.2%) cases and congenital coronary aneurysm was present in 6 (1.1%) cases. The recognition of coronary artery anomalies shortens the duration of coronary angiography and mitigates the radiation exposure for both the operators and the patients. Also, it is important to know if there is any anomaly in origin or in course of coronary arteries before cardiac surgery to avoid complications.

An unusual co-anomaly: multiple coronary-cameral fistulas and left main coronary artery arising from the right sinus of Valsalva

A 70-year-old female patient was referred to the Cardiology Department for preoperative evaluation before undergoing total hysterectomy. She had no chest pain, but had experienced exertional dyspnea over the past several months. Besides age, she had no additional risk factors for coronary artery disease. Electrocardiogram showed normal sinus rhythm and nonspecific T wave changes, with a heart rate of 81 beats per minute. The physical examination was unremarkable, and exercise stress test was non-diagnostic. Coronary angiography revealed anomalous left main coronary artery (LMCA) arising from the right sinus of Valsalva (Fig. A, Video 1*) and the presence of multiple coronary-cameral fistulas (CCF) between the left ventricle and septal perforating branches of the left anterior descending (LAD) and right coronary arteries (Fig. B, Video 2; Fig. C, Video 3). According to the eye-dot method (Fig. B) and given the septal perforator branch before the LMCA bifurcation (Fig. A), its course was considered as septal, which was confirmed by computed tomography coronary angiography (CTCA) (Fig. D). Because of the benign nature of the abnormal septal course of the LMCA and clinically insignificant CCF, the patient was treated conservatively with β-blockers. She did not experience any chest pain during the hysterectomy and had an uneventful postoperative course. CCF is an uncommon clinical entity, which is defined as an anomalous communication between any epicardial coronary artery and the cardiac chambers. The functional significance and treatment of these fistulas remain unclear. As in our case, CCF originating from both coronary arteries and terminating in cardiac chambers is one of the least common forms. The anomalous origin of LMCA arising from the right sinus of Valsalva is quite rare, with an incidence of 0.1%. It has four possible courses: inter-arterial, retro-aortic, septal, and anterior. The clinical significance and management strategies in these arteries depend on the initial course of the anomalous vessel. In 1990, Serota et al. defined the ‘Dot and Eye’ method for identification of the initial course of anomalous coronary arteries in coronary angiography. In a septal course, the circumflex artery (Cx) will form an ellipse to the left of the aorta, similar to an ‘eye’, with the LMCA forming the inferior portion and the Cx forming the superior portion during 30 RAO injection. In conclusion, CTCA can visualize coronary anomalies accurately; however, a correct diagnosis can be made safely in selected cases by conventional angiography in the presence of clues. 782

Multidetector computed tomography imaging of coronary artery anomalies

The purpose of the study was to determine the prevalence of coronary artery anomalies and to demonstrate in which cases multidetector computed tomography has an additional clinical value compared with the conventional angiography. A total of 2375 multidetector computed tomography studies were retrospectively reviewed to determine the dominance of the coronary artery anomalies. The classification of coronary artery anomalies was made according to anatomical criteria--origin, course, intrinsic anatomy, and termination--and clinical relevance--benign versus malignant. The coronary artery system was right dominant in 83.99%, left dominant in 8.0%, and co-dominant in 9.01% of the cases. The incidence of the origin and/or course anomalies was 1.76%, that of fistulas was 0.42%, and that of myocardial bridges was 10.82%. Multidetector computed tomography was performed after conventional angiography in 23 cases and it provided additional information regarding its origin and proximal course, as well as its relationship with the aortic root and main pulmonary trunk in 100% of the cases; eight malignant cases were found. In addition, in all of (100%) the six cases with coronary artery fistulas, conventional angiography failed to detect their terminations, which were clearly depicted by multidetector computed tomography. Multidetector computed tomographic angiography is superior to conventional angiography in delineating the ostial origin and proximal course of anomalous coronary arteries. Furthermore, it reveals the exact relationship of anomalous coronary arteries with the aorta and the pulmonary artery. Anomalies of the intrinsic anatomy and the termination of coronary arteries are also better visualised with multidetector computed tomography.

An interarterial course of anomalous coronary artery and an alternative surgical option

An interarterial course of anomalous left main coronary artery originating from the right aortic coronary sinus of valsalva is a rare condition among anomalous aortic origin of the coronary artery. Various surgical options are available. We performed an alternative procedure, that is, mobilisation of the pulmonic root, pulmonary bifurcation, and plication of the pulmonic root adjacent to the left main coronary artery, in a 12-year-old boy. Favourable results were achieved after 43 months of follow-up.

Improper aortic sinus-connected coronary artery: Ascertaining the course is essential (Comment on Ann Saudi Med 2010;1:81-3)

Improper aortic sinus-connected coronary artery: Ascertaining the course is essential (Comment on Ann Saudi Med 2010;1:81-3)

Percutaneous coronary intervention of an anomalous right coronary artery originating from the left coronary artery

Anomalous origin of the right coronary artery is a rare congenital anomaly that was first described in 1948 by White and Edwards. It is well established that an anomalous origin of the right coronary artery can lead to angina pectoris, myocardial infarction, or sudden death, in the absence of atherosclerosis. Thus from the literature data it has been also suggested that the abnormal origin and course of anomalous coronary arteries could make them more prone to atherosclerosis due to altered flow patterns. We report our experience involving one patient who had significant atherosclerotic disease and was successfully treated with percutaneous coronary intervention (PCI) and stent implantation in an anomalous right coronary artery arising from the left coronary artery.

Comparison of fluoroscopic coronary angiography and multi-slice coronary angiography in the characterization of anomalous coronary artery

Anomalous coronary arteries with an inter-arterial course are associated with sudden cardiac death. We reported a study comparing the accuracy of fluoroscopic coronary angiography (FCA) with that of multi-slice computed tomography (MSCT) coronary angiography in determining the proximal course of anomalous coronary arteries. Twelve patients with thirteen anomalous coronary arteries had both FCA and MSCT coronary angiography were included in this study. Twelve cardiologists individually reviewed FCAs of anomalous coronary arteries and determined the proximal course of anomalous coronary arteries as retro-aortic, inter-arterial or ante-pulmonary. Their diagnoses were compared with MSCT coronary angiography which was regarded as the reference standard in this study. On MSCT coronary angiography, there were six anomalous left circumflex arteries with a retro-aortic course, five anomalous right coronary arteries and one anomalous left anterior descending artery with inter-arterial courses, and a single anomalous left main artery with an ante-pulmonary course. The percentage of correct diagnosis made by 12 cardiologists based on FCA findings was 93/156 or 60%. None of the cardiologists was correct in determining the proximal course of all anomalous coronary arteries. The median number of anomalous coronary arteries with their proximal courses correctly identified by the cardiologists was 7.5 (range 3–12). In conclusion, FCA was limited in delineating the proximal course of anomalous coronary arteries in comparison with MSCT coronary angiography.

Contrast-Enhanced 64-Slice Computed Tomography in Detection and Evaluation of Anomalous Coronary Arteries

Anomalous coronary artery (ACA) has either an unusual origin or different anatomical course and is associated with sudden cardiac death. The absence or nonspecific symptoms of ACA make its diagnosis difficult. Mostly, ACA is diagnosed coincidentally during invasive coronary angiogram (ICA). A conventional computed tomography (CT) cannot provide detailed images of coronary arteries of the moving heart, but 64-slice CT, with its short acquisition time, can provide detailed anatomy of coronary arteries non-invasively. In this study, we assessed the validity of contrast-enhanced 64-slice CT in the evaluation of ACA. ICA was performed in 7,574 patients for the diagnosis or evaluation of occlusive coronary artery disease and detected coronary anomalies in 56 patients (0.7%). We then performed 64-slice CT in 53 patients out of the 56 patients with demonstrated or suspected coronary anomaly, showing the origin and the course of the ACA along with stenosis, except for one patient who could not be evaluated due to image distortion artifacts. Contrast-enhanced 64-slice CT was also performed in 374 patients with vague signs and symptoms, detecting coronary anomalies in 7 patients (1.2%). Thus, in the total of 59 patients undergone 64-slice CT, we were able to visualize the entire abnormal coronary tree with a high diagnostic image quality. This is the first study to demonstrate the utility of 64-slice CT in a large series of ACA. Contrast-enhanced 64-slice CT is superior to ICA to identify the presence and course of ACA and should be the first line diagnostic tool in the evaluation of ACA.

Anomalous Coronary Arteries Originating in the Contralateral Sinus of Valsalva: Registry of Thirteen Spanish Hospitals (RACES)

The registry contains information collected during 2003 from thirteen Spanish hospitals on the incidence, clinical presentation, initial course, diagnostic imaging, and treatment of anomalous coronary arteries originating in the contralateral coronary sinus. In a total of 23,300 coronary angiograms, 98 anomalous coronary arteries were detected (incidence 0.4%): 46 circumflex coronary arteries (47%), 25 right coronary arteries (25.5%), 10 left main coronary arteries (10.2%), three left anterior descending arteries (3.1%), six single coronary arteries (6.1%), and eight other anomalies (8.2%). The most frequent indication for angiography was angina (43.9%). The initial course of the anomalous coronary artery was not identified in 40.8% of cases. In two patients (2%), diagnostic imaging was used to identify the initial course. Associated atherosclerotic disease was present in 51% of patients. In addition, 18.4% had associated valvular disease, with the aortic valve being affected most often (15.2%). Some 16.3% of patients underwent treatment for the coronary anomaly. The incidence was similar to that observed in other published series, with anomalies in the circumflex coronary artery being diagnosed most frequently. Diagnostic imaging was underused.

Congenital coronary anomalies in adults: Comparison of anatomic course visualization by catheter angiography and electron beam CT

The objective of this study was to compare the anatomic course of anomalous coronary arteries by axial and three-dimensional volume-rendered electron beam computed tomography (EBCT) angiography and X-ray catheter angiography (CAG). We performed a blinded study where patients who previously underwent CAG with (n = 14) and without (n = 14; age- and gender-matched controls) anomalous coronary anatomy were studied with EBCT coronary angiography. Forty to 50 EKG-triggered 3 mm overlapping axial slices were acquired with 2 mm table movement within one breath hold during the i.v. injection of 140 cc of nonionic iodinated contrast (4 ml/sec). The axial source images and volume-rendered three-dimensional reconstructions were evaluated for the presence, type, and course of coronary anomalies and the results were compared to those of CAG. All normal and anomalous coronary arteries were identified by both modalities in all subjects. Identified anomalies include single coronary artery (n = 3), left-sided right coronary artery (n = 3), right-sided left main coronary artery (n = 3), anterior descending coronary artery (n = 2), circumflex coronary artery (n = 2), and separate left-sided ostia for left anterior descending and circumflex coronary arteries (n = 1). In five cases, there was discrepancy in the course of the anomalous vessels between the two modalities. Consensus reading among cardiologist and radiologists favored the interpretation of EBCT over catheter angiography. Noninvasive EBCT coronary angiography compares well with CAG in identifying anomalous coronary arteries and may provide confirmatory evaluation of their precise anatomic relationships to the heart and great vessels.

Detection, visualization and evaluation of anomalous coronary anatomy on 16-slice multidetector-row CT.

Early identification and evaluation of relatively frequent anomalous coronary anatomy is quite relevant because of the occurrence of sudden cardiac death or related symptoms of myocardial ischemia. Selective coronary angiography (CAG) is invasive, expensive and cannot always provide the required information adequately. Recently, non-invasive imaging techniques such as magnetic resonance imaging and multidetector-row computed tomography (MDCT) have been shown to provide a good anatomical view of the coronary artery tree. This study aims to demonstrate the value of 16-MDCT for evaluation of anomalous coronary anatomy. In 13 patients scanned using 16-MDCT, six different coronary anomalies were diagnosed [two absent left main, one single vessel left coronary artery (LCA), three LCA originating from the right (two with interarterial course), six right coronary artery originating from the left, one double left anterior descending (LAD)]. Mean diagnostic quality, recorded by two observers using a 5-point scale (1= non-diagnostic to 5= excellent diagnostic quality), resulted in a mean score of 3.73 (SD 1.19) without any non-diagnostic result. MDCT offers an accurate diagnostic modality to visualize the origin and course of anomalous coronary arteries by a three-dimensional display of anatomy. Shortcomings in CAG can be overcome by the use of contrast-enhanced MDCT.

853 Transesophagel echocardiography to evaluate the anatomic course of anomalous coronary arteries and the ischemia at stress-rest scintigraphy in adults

853 Transesophagel echocardiography to evaluate the anatomic course of anomalous coronary arteries and the ischemia at stress-rest scintigraphy in adults

Evaluation of rerouting surgery of a coronary artery anomaly by magnetic resonance angiography

A 25-year-old woman presented with episodes of palpitations, near-collapse, and chest pain. Physical examination revealed no abnormalities. Resting electrocardiogram showed sinus rhythm, normal heart axis without conduction abnormalities, and inverted T waves in leads V1 through V3. Laboratory tests and chest roentgenogram were normal. During exercise testing a nonsustained ventricular tachycardia (230 beats per minute) occurred. Coronary angiography showed an anomalous origin of the right coronary artery (RCA) from the left aortic sinus with a separate ostium. Atherosclerotic changes were not present. The coronary angiogram was inconclusive about the exact course of the RCA and therefore free-breathing, threedimensional coronary magnetic resonance angiography was performed using a 1.5 T MR scanner (Gyroscan ACSNT; Philips Medical Systems, Eindhoven, the Netherlands) [1]. Preoperative coronary magnetic resonance angiography revealed an interarterial course of the RCA between the aorta and pulmonary trunk (Fig 1; Ao aorta, PT pulmonary trunk). This malignant course is associated with an increased risk for myocardial infarction and sudden death, therefore surgical rerouting was planned. At inspection during surgery the ostium of the RCA was located above the commissure between the left and right coronary cusps and proximally coursing within the aortic wall. A small scar was observed in the inferior wall. The slit-like ostium was removed from the aorta and unroofing was performed. Then the ostium was reimplanted in the right coronary sinus. A xenopericard patch was used to close the aortic defect. Aortic regurgitation was excluded by intraoperative transesophageal echocardiography. Postoperative electrophysiological testing could not induce ventricular arrhythmias. After surgery coronary magnetic resonance angiography was repeated and evaluated the success of the rerouting procedure and postoperative course of the RCA (Fig 2; Ao aorta; LV left ventricle; PT pulmonary trunk; RV right ventricle). In our patient, the ventricular tachycardias most likely were caused by paroxysmal ischemia or infarction due to an anomalous RCA. Coronary magnetic resonance angiography can be used to identify the exact course of anomalous coronary arteries and in this case was also applied successfully to evaluate the course of the RCA after surgical rerouting.

3-dimensional MR coronary angiography with navigator technique: imaging of the proximal course of a coronary artery anomaly

Congenital coronary artery anomalies are found in 0.3 to 1.3% of patients and can cause ischemic heart disease or sudden cardiac death, especially if the anomalous coronary artery courses between the aortic root and the pulmonary artery. Identification of the anatomic course of the anomalous vessel is not always feasible by conventional radiographic coronary angiography. With MR coronary angiography not only flowing blood but also the vessel anatomy can be imaged. In previous studies, a two-dimensional gradient-echo sequence during breathhold was used demanding both cooperation of the patient and operator skill. The navigator technique reduces respiratory artifacts by retrospective respiratory gating on the diaphragm's position, obviating the need for breathhold studies. Furthermore, the three-dimensional MR coronary angiography enables post-processing using the Volume Rendering Technique for evaluation of three-dimensional view. We report on the use of this technique for the identification of the course of anomalous coronary arteries in two patient cases.