Incidence Of Coronary Artery Anomalies Research Articles

UNUSUAL BEGINNINGS: A CASE OF ABERRANT CORONARY ARTERY ANATOMY

UNUSUAL BEGINNINGS: A CASE OF ABERRANT CORONARY ARTERY ANATOMY

ACUTE ANTERIOR WALL MYOCARDIAL INFARCTION BY AN ANOMALOUS MID LEFT ANTERIOR DESCENDING ARTERY ORIGINATING FROM THE PROXIMAL RIGHT CORONARY ARTERY

SESSION TITLE: Etiologies of Cardiovascular Disease Case Report PostersSESSION TYPE: Case Report PostersPRESENTED ON: 10/19/2022 12:45 pm - 01:45 pmINTRODUCTION: The estimated incidence of coronary artery anomalies is up to 1%.CASE PRESENTATION: A 50-year-old man with peripheral artery disease and drug abuse was brought to the emergency department unresponsive post cardiac arrest.Before arrival, he had ventricular fibrillation which progressed to asystole.He received two defibrillations, cardiopulmonary resuscitation, epinephrine, and amiodarone before return of spontaneous circulation. On arrival, he was intubated.EKG showed ST-segment anterior ST-elevations.The patient emergently transported to the cardiac catheterization laboratory.Diagnostic coronary angiography showed a 100% thrombotic stenosis of the second diagonal branch and an anomalous mid and distal LAD originating from the proximal RCA.The D2 was repaired successfully with a 2.5 x 34 mm Resolute Onyx drug-eluting stent.Following decision was made to pursue a dual injection to evaluate for a mid and distal LAD arising as a branch from the conus. Following a 6F JR5 catheter was used to engage the RCA.Dual injections were performed in multiple projections, and a mid and distal LAD arising from the conus was confirmed.At the end of the procedure, the EKG showed resolution of the ST elevations. The patient was transferred to the intensive care unit.DISCUSSION: These anomalies are generally asymptomatic, but rarely may lead to myocardial ischemia/infarction and/or sudden death.In particular, STEMI is a rare clinical presentation and identification of the culprit lesion with subsequent emergent PCI can be challenging in this setting.CONCLUSIONS: We report a rare case of cardiac arrest due to 100% thrombotic occlusion of culprit anomalous LAD originating from RCA leading to acute anterior wall myocardial infarction.Reference #1: Kheirkhah J, Sadeghipour P, Kouchaki A. An anomalous origin of left anterior descending coronary artery from right coronary artery in a patient with acute coronary syndrome. J Tehran Heart Cent. 2011 Nov;6(4):217-9. Epub 2011 Nov 30. PMID: 23074373; PMCID: PMC3467955.DISCLOSURES: No relevant relationships by Samiullah ArshadNo relevant relationships by Huzefa BhopalwalaNo relevant relationships by Nakeya Dewaswalano disclosure on file for Hussam Fawzi Ahmad Hawamdeh;no disclosure submitted for Andrew Leventhal;no disclosure submitted for Adrian Messerli;No relevant relationships by Vinayak Mishra SESSION TITLE: Etiologies of Cardiovascular Disease Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: The estimated incidence of coronary artery anomalies is up to 1%. CASE PRESENTATION: A 50-year-old man with peripheral artery disease and drug abuse was brought to the emergency department unresponsive post cardiac arrest. Before arrival, he had ventricular fibrillation which progressed to asystole. He received two defibrillations, cardiopulmonary resuscitation, epinephrine, and amiodarone before return of spontaneous circulation. On arrival, he was intubated. EKG showed ST-segment anterior ST-elevations. The patient emergently transported to the cardiac catheterization laboratory. Diagnostic coronary angiography showed a 100% thrombotic stenosis of the second diagonal branch and an anomalous mid and distal LAD originating from the proximal RCA. The D2 was repaired successfully with a 2.5 x 34 mm Resolute Onyx drug-eluting stent. Following decision was made to pursue a dual injection to evaluate for a mid and distal LAD arising as a branch from the conus. Following a 6F JR5 catheter was used to engage the RCA. Dual injections were performed in multiple projections, and a mid and distal LAD arising from the conus was confirmed. At the end of the procedure, the EKG showed resolution of the ST elevations. The patient was transferred to the intensive care unit. DISCUSSION: These anomalies are generally asymptomatic, but rarely may lead to myocardial ischemia/infarction and/or sudden death. In particular, STEMI is a rare clinical presentation and identification of the culprit lesion with subsequent emergent PCI can be challenging in this setting. CONCLUSIONS: We report a rare case of cardiac arrest due to 100% thrombotic occlusion of culprit anomalous LAD originating from RCA leading to acute anterior wall myocardial infarction. Reference #1: Kheirkhah J, Sadeghipour P, Kouchaki A. An anomalous origin of left anterior descending coronary artery from right coronary artery in a patient with acute coronary syndrome. J Tehran Heart Cent. 2011 Nov;6(4):217-9. Epub 2011 Nov 30. PMID: 23074373; PMCID: PMC3467955. DISCLOSURES: No relevant relationships by Samiullah Arshad No relevant relationships by Huzefa Bhopalwala No relevant relationships by Nakeya Dewaswala no disclosure on file for Hussam Fawzi Ahmad Hawamdeh; no disclosure submitted for Andrew Leventhal; no disclosure submitted for Adrian Messerli; No relevant relationships by Vinayak Mishra

INCIDENCE OF CORONARY ARTERY ANOMALY IN SLEMANI CARDIAC HOSPITAL

Background 
 Coronary arteries are classified traditionally into three different groups according to their anatomy, normal anatomy, anatomical variations, and anomaly. The incidence of coronary artery anomaly (CAA) can vary from as low as 0.2% to as high as 5.64% of the general population.
 Objectives 
 To find the incidence of coronary artery anomalies in the Sulaimani Cardiac Center.
 Materials and Methods
 A Prospective case study was carried out on patients undergoing emergency and elective coronary catheterization in Sulaimani cardiac hospital from January 2021 to January 2022. After a complete history and physical examination, their coronary angiogram reports were evaluated for the coronary anomaly.
 Results
 A total of 3,127 patients were evaluated, with coronary anomalies in 144 patients with an incidence of 4.6%. The mean age was 60.2± 11, ranging from 24 to 92 years. The male gender was 66.7%(n=96). The presenting complaint in this study was predominantly chest pain, 78.5%(n=48). The acute coronary syndrome was the cause of urgent coronary angiography in 22.9% (n=33). The myocardial bridge was the most predominant among our patients 41% (n=59), followed by the Separate origins of the Left Anterior Descending Artery and Left Circumflex Artery in the Left sinus of the Valsalva, 38.2%(n=55). While Anomalies of coronary termination (fistula) were found in 4.9%(n=7), 
 Conclusion
 Coronary artery anomalies are uncommon findings in patients undergoing coronary angiography with an incidence of 4.6%, The most common anomaly detected in our study was myocardial bridging.

Coronary artery anomalies and dominance: data from a single center in Turkey.

Coronary artery anomalies (CAA) are found in 0.2% to 1.3% of coronary angiograms. The aim of the presented study was to describe congenital CAA and their variations, also identifying the prevalence of these anomalies and coronary artery dominance in our center. A total of 7858 patients were included in the study retrospectively between August 2015 and March 2020. Patients undergoing coronary angiography (CAG) were reviewed by at least 2 independent and experienced observers. The Angelini's CAA Classification method was used to classify patients. Coronary dominance was determined according to the artery from which the posterior desending artery originated. CAA was detected in 88 (1.1%) out of 7858 patients. Of these patients, 73 (82.9%) had anomalies of origination and course called group A, 7 (7.9%) had anomalies of intrinsic coronary arterial anatomy called group B, and 8 (9.1%) had anomalies of coronary termination called group C. Anomalous collateral vessels called group D were not detected. RCA dominance was N.=5579 (70.99%), Cx dominance was N.=1021 (12.99%), and codominancy was N.=1258 (16.01%). The incidence of CAA was 1.1% in total and is compatible with other major studies. According to the Angelini CAA clasification, group B anomalies are observed more frequently than other studies. Cx dominance is moderately high.

Frequency of coronary artery anomalies and relationship between coronary artery with anomalous origin and myocardial bridge

The association between coronary artery with anomalous origin and myocardial bridge is not investigated well yet. We aimed to investigate the incidence of coronary artery anomalies and the relationship between coronary artery with anomalous origin and the presence of myocardial bridge. The coronary angiography records of 6100 patients who undergone coronary angiography in Eskisehir Osmangazi University – school of medicine hospital between 2008 and 2010 were retrospectively assessed. The Angelini classification system was used to classify the coronary artery anomalies. Coronary arteries were classified in three classes: (i) Coronary artery with anomalous origin, (ii) abnormal course (myocardial bridge) and; (iii) termination (fistula). Myocardial bridge is a type of coronary anomaly and is defined as the case where a segment of the epicardial coronary artery is covered by myocardium. The incidence of coronary artery anomalies was 3.1%. Coronary artery with anomalous origin was 1.5%, myocardial bridge was 1.4% and fistula was 0.3%. The frequency of coronary artery anomalies was significantly higher in males (66.7%) than in females (33.3%). Among the coronary arteries with anomalous origin, the circumflex and left descending artery originating from separate ostia in the left aortic sinus was the most common anomaly. Myocardial bridge was significantly higher in males (81.9%) than in females (18.07%). Among the coronary artery with anomalous origin, originating of right coronary artery from left sinus of valsalva was significantly higher with the presence of myocardial bridge (p

Coronary artery anomalies: Unusually high incidence of anomalies with a malignant course in an Asian population.

Objectives:Coronary artery anomalies are uncommon, but important cardiac malformations, representing the second commonest cause of death in young athletes.Methods:We utilized computerized tomographic angiography to screen and precisely delineate coronary artery anomalies in patients with minimal cardiac symptoms.Results:During 3.5-year period, we performed 2888 computerized tomographic angiographies. A total of 33 (1.1%; 95% confidence interval = 0.7–1.5) cases of coronary artery anomalies were identified (mean age = 44 ± 13.5 (15–70) years). In total, 23 patients (mean age = 43 years) had malignant coronary artery anomalies with an inter-arterial course of the aberrant vessel: of which 3 had left main coronary artery arising from right coronary sinus and 20 right coronary artery from left sinus; 19 patients were of Asian and 14 were of Arab origins. Of interest, 21 out of 33 patients had chest pain, 5 had palpitations, and 2 had breathlessness. There were no examples of sudden cardiac death. All patients received appropriate advice regarding physical exertion and medical management, and remained well for 2–5 years of follow-up. Of 33 patients, 4 had significant symptomatic coronary artery disease requiring intervention: 1 percutaneous coronary intervention and 3 coronary artery bypass graft surgery.Conclusion:There is a relatively high incidence of coronary artery anomalies with malignant course in Asians. The vast majority were managed conservatively.

Incidence of coronary artery anomalies among patients undergoing coronary angiography and its relevance to appropriate choice of coronary catheter selection

Incidence of coronary artery anomalies among patients undergoing coronary angiography and its relevance to appropriate choice of coronary catheter selection

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.

128-Slice MDCT angiographic evaluation of coronary artery anomalies in the South Asian (Indian) population – A first experience

ObjectiveTo identify the incidence of coronary artery anomalies and their subtypes in the South Asian (Indian) population using 128-slice MDCT angiography. MethodsThis was a retrospective study involving 3300 patients who were referred for coronary MDCT angiography over a period of 8 years (2008–2016). All patients were evaluated by means of 128 slice MDCT scanner (SIEMENS SOMATOM AS+). ResultsA total of 171 coronary artery anomalies (5.2%) were identified. These included 109 peripheral branch anomalies, 56 ACAOS with abnormal course, 5 anomalies of coronary origin only & 1 coronary arterio-venous fistula. Of these 28 RCA anomalies had malignant interarterial course and 27 LCA anomalies had benign retroaortic course and one with intramyocardial course. Conclusion128 slice MDCT coronary angiography provides high temporal & spatial resolution along with a very precise volume rendering 3D imaging which enables the diagnosis of coronary artery anomalies unchallenging. Our study showed that the incidence of coronary artery anomalies was far higher in the Indian population when compared with the western or global population, emphasising further the need for such a study, in view of the high incidence of cardiovascular diseases in India when compared with the rest of the world.

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.

Unusual aberrancy of right coronary artery (RCA) in patient with double-outlet right ventricle (DORV) with pulmonary stenosis (PS)

The incidence of coronary artery anomalies in double-outlet right ventricle (DORV) or tetralogy of Fallot (TOF) has been reported to be 2% to 10%. Surgical correction in such a scenario, across a narrowed and under-developed right ventricular outflow tract (RVOT), poses a significant challenge and has been associated with increased morbidity and mortality. These combinations at times may change the approach of primary repair to one of initial palliation. Single coronary artery, meaning anomalous origin of the right coronary artery from the left anterior descending artery, is a benign and very rare coronary artery anomaly. Here, we report the case of an 11 year-old boy with double-outlet right ventricle (DORV) with pulmonary stenosis (PS) where pre-operative catheterisation and multi detector CT angiography (MDCT) revealed anomalous right coronary artery arising from left anterior descending artery.

Coronary anatomy, anatomic variations and anomalies: a retrospective coronary angiography study.

The incidence of coronary artery anomalies (CAAs) varies from 0.2% to 8.4%. Knowledge of such anatomical variations is important as coronary procedures are regularly performed these days. We aimed to find the coronary dominance pattern, intermediate artery (IMA) frequency and CAA incidence in our clinic, and compare them to those in the literature. The medical reports of 5,548 patients who had undergone coronary angiography (CAG) between 2005 and 2009 were retrospectively investigated. Dominance pattern and presence of IMA and CAA were recorded. CAAs were described using two different classifications: Angelini and Khatami's classification, and a new modified classification that was derived from Angelini and Khatami's classification. Some procedural details and clinical features of the patients with CAA were also investigated. Coronary dominance pattern was: 81.6% right coronary artery, 12.2% circumflex artery and 6.2% co-dominant. IMA was present in 613 (11.0%) patients. The incidences of overall anomaly were 2.7% and 1.4%, according to the different classifications. Absent left main coronary artery, which was the most common anomaly in the present study, was found in 51 (0.9%) patients. Incidences of myocardial bridge, coronary arteriovenous fistulae and aneurysms were 1.1%, 0.2% and 0.3%, respectively. CAAs are generally asymptomatic, isolated lesions. Some may lead to anginal symptoms, myocardial infarction or sudden death. We found that CAA was associated with increased radiation and contrast exposure in patients who underwent CAG. This risk could be reduced if appropriate catheters were designed and training programmes on ostial cannulation were developed.

Anectodal Report of Anomalous Circumflex Associated with Pathological Scintigraphy in a Patient with Atypical Chest Pain.

The incidence of Coronary Artery Anomalies (CAA) in routine Coronary Angiography(CAG) is between 0.6% and 1.5%. Most anomalies are not of clinical significance, but some are related to angina, dyspnoea, syncope, acute myocardial infarction andsudden death. Diagnosis and adequate imaging of CAA are crucial for appropriate patient management, especially in patient candidates for Percutaneous Coronary Intervention (PCI) and cardiac surgery. This report describes the anomalous origin of the Left Circumflex Artery (LCX), arising by the right sinus of Valsalva and associated with the presence of hypoplasicLeft Anterior Descending Coronary Artery (LAD) that correlates with myocardial scintigraphy findings of reduced uptake in the anterior and inferior wall of left ventricle.

Successful Primary Percutaneous Intervention to the Circumflex Artery Originating From Right Coronary Artery

The incidence of coronary artery anomalies are reported in to of the population Although their freuency is rare, these congenital anomalies are important due to their relation ith myocardial infarction and sudden cardiac death In this case, e presented a years old male patient ho has been admitted to our emergency service ith acute posterior myocardial infarction and transferred to the catheterisation laboratory for the purpose of primary percutaneous coronary intervention Coronary angiography revealed culprit lesion in anomalous circumfle artery originating from the proimal part of the right coronary artery and the patient as treated ith successful primary angioplasty and stent implantation ( Sakarya Med J 2015, 5(4):236-239 ) Keywords: Coronary artery anomalies Acute myocardial infarction ercutaneous coronary intervention

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.

Prevalence of congenital coronary artery anomalies and variants in 726 consecutive patients based on 64-slice coronary computed tomography angiography

Coronary computed tomography angiography (CCTA) is helpful in making a precise noninvasive evaluation of coronary anatomy, allowing concomitant evaluation of other cardiac structures. The aim of this study was to determine the prevalence of coronary artery variations detected by 64-slice multi detector CT. The results of ECG-gated CCTA in 726 consecutive patients (mean age 58 years) were analysed retrospectively. The main indications for CCTA were a typical chest pain, angina pectoris, screening for coronary artery disease and determination of the patency of bypass grafts or stents. Acquisition was performed with a 64-detector CT scanner with retrospective ECG gating. Imaging results were assessed by experienced cardiovascular radiologist. The overall incidence of coronary artery anomalies was 1.1% (8 out of 726 participants). The most common anomaly was an anomalous origin of the circumflex artery from the right coronary sinus with a retroaortic course (4 patients,0.6%), followed by origin of right coronary artery from the left coronary sinus (2 patients, 0.3%). One patient with abnormal origin of the left main artery from the right coronary sinus (0.1%) and 1 patient with a circumflex artery origin from the proximal segment of the right coronary artery (0.1%) were observed, both with retroartic course. CCTA is a noninvasive imaging technique useful for the precise evaluation of variations of the coronary arteries. This study shows similar results to other reports on this subject.

Congenital anomalies of coronary arteries in complex congenital heart disease: Diagnosis and analysis with dual-source CT

BackgroundCongenital heart diseases (CHDs) are sometimes associated with coronary artery anomalies (CAAs). Accurate preoperative evaluation of coronary artery anatomy is essential for successful surgical repair of complex CHD. ObjectiveThe aim of this study was to evaluate the incidence of congenital CAAs in patients with complex CHD at dual-source CT. MethodsFour hundred seventeen consecutive patients with complex CHD underwent contrast-enhanced cardiac CT angiography. The results were retrospectively analyzed, including the types and incidences of CAAs in various forms of complex CHD. Each patient was analyzed independently by 2 experienced cardiovascular radiologists. Image quality of coronary arteries was assessed on a 5-point scale with 2 or less being nondiagnostic. ResultsThirty-five of 417 studies were nondiagnostic (8.39%). Sixty-three cases of CAA (15.11%) were detected by anomalous ostia and coronary arteries. CAA was involved in 6 of 108 patients with tetralogy of Fallot (5.56%), 18 of 84 patients with double outlet right ventricle (21.43%), 11 of 97 patients with pulmonary artery atresia (11.34%), 7 of 36 patients with transposition of the great arteries (22.22%), 15 of 41 patients with single ventricle (36.59%), 4 of 12 patients with truncus arteriosus/aortopulmonary window (33.33%), and 2 of 39 patients with interruption of the aortic arch/coarctation of the aorta (5.13%). Twenty of these were accompanied with an anomalous coronary course (31.74%). ConclusionPatients with complex CHD have a higher prevalence of CAAs, which should be considered before surgery. Dual-source CT is an effective technique to visualize and evaluate complex CHD.

Relationship between significant coronary artery disease and coronary artery anomalies

Purpose: In the present study we aimed to investigate the frequency and types of Coronary Artery Anomalies (CAAs) and their correlation with Coronary Artery Disease (CAD). Methods: We assessed retrospectively the coronary angiography records of 8120 adult patients. We defined and classified the CAAs according to the classification system described by Angelini et al. Significant CAD was defined as the presence of angiographic coronary stenosis >50% of the luminal diameter in at least one of the epicardial coronary arteries. Moreover, we compared the frequencies and features of the CAAs between the CAD. Results: We detected coronary artery anomalies in 3.32% and 64.4% of the patients contained the significant CAD. The percentage of anomalous coronary artery origin was significantly higher in CAD (-) patients than CAD (+) patients. The incidence of the absence of Left Main Coronary Artery (LMCA) and the left anterior descending artery originating from the right sinus of Valsalva or the right coronary artery was significantly higher in CAD (-) patients than CAD (+) patients. View this table: Table 1. The incidence of CAA with regard to the presence of a coronary artery disease Conclusion: The development of coronary artery disease might be associated with coronary artery anomalies. In particular, the lack of LMCA seems to restrict the development of CAD.

Prevalence and characteristics of coronary artery anomalies in 12401 adult patients: a coronary angiographic study from Northern Greece

Purpose: Since regional and ethnic variations of the incidence of CAA have been reported, our aim was to estimate their incidence in a population from Northern Greece, which has not been previously studied. Methods: A series of 12401 coronary angiograms, performed between January 2003 and December 2011 in a cardiac catheterization unit at our institution was retrospectively reviewed for the presence of coronary artery anomalies. Results: The overall incidence of isolated coronary artery anomalies was 1.35% (167/12401, mean age: 62.9±11.6 years, males: 74.3%). The most common coronary anomaly was separate ostia for Left Anterior Descending artery (LAD) and circumflex artery (Cx) inside the left sinus of Valsava (SoV), with an incidence of 0.48% (59/12401) or 35.3% of all coronary anomalies. The second most common anomaly was origin of Cx from the right side with an incidence of 0.35% (43/12401) or 25.7% of all coronary anomalies. Regarding the anomalous origin of the Cx from the right SoV, three distinct anatomical variants of the ostium of the anomalous left circumflex coronary artery were identified: a) separate ostia for Right Coronary Artery (RCA) and anomalous circumflex within the right sinus of Valsalva (type I, n=20, 46.5%), b) common ostia in the right sinus (type II, n=13, 30.2%), and c) Cx arising arising as a branch of the proximal RCA (type III, n=10, 23.3%). In all cases the anomalous Cx had a posterior course to the aorta. Anomalous RCA origin was found in 41 cases (0.33% or 24.6% of all coronary anomalies). It originated separately from the left sinus of Valsalva (SV) in eighteen patients (an incidence 0.14% or 10.8% of all anomalies). A single coronary artery arising from the right SoV was seen in four patients (0.03% or 2.4% of anomalies). An absent circumflex or super-dominant RCA in 2 cases (0.02% or 1.2% of anomalies). In this series we also found also seventeen cases of coronary fistulas (0.13% or 10.2% of anomalies). In one patient coronary angiography revealed congentital left main coronary artery atresia (0.008%) with a dominant RCA providing intercoronary retrograde collateral to the left anterior descending artery (LAD) and left circumflex artery (LCx). Conclisions: The incidence of coronary artery anomalies in our study population was 1.35%. The most common type was separate ostia for LAD and Cx inside the left SoV and second most common the origin of the Cx from the right sinus of Valsalva. Although geographic variations in the incidence of CAA have been reported, these results are in agreement with previously published large angiographic series.

ASSA13-05-3 Anomalous Left Main Coronary Artery Arising From The Right Sinus Of Valsalva

<h3></h3> Congenital anomalies of the coronary arteries are an uncommon but important cause of chest pain and sudden cardiac death. The incidence of coronary artery anomalies has been reported between 0.6 to 1.3% in angiography and 0.3% in autopsy. The anomalous origin of left and right coronary arteries from a single coronary ostium in the right sinus of Valsalva is extremely rare and accounts for a small fraction of these anomalies with reported prevalence of 0.017% to 0.03% according to angiographic studies. We report a case of 52-year-old woman, suffering from chest pain, with an anomalous common origin of all coronary arteries from the right sinus of Valsalva.