Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Coronary Artery Anomalies Differential Diagnoses

  • Author: Louis I Bezold, MD; Chief Editor: Stuart Berger, MD  more...
 
Updated: Jan 05, 2015
 
 
 
Contributor Information and Disclosures
Author

Louis I Bezold, MD Professor, Department of Pediatrics, Ohio State University College of Medicine; Director, Cardiology Consultation Service, Nationwide Children's Hospital

Louis I Bezold, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Society of Echocardiography, Society of Pediatric Echocardiography

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Julian M Stewart, MD, PhD Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College

Julian M Stewart, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Autonomic Society, American Physiological Society

Disclosure: Received grant/research funds from Lundbeck Pharmaceuticals for none.

Chief Editor

Stuart Berger, MD Medical Director of The Heart Center, Children's Hospital of Wisconsin; Associate Professor, Department of Pediatrics, Section of Pediatric Cardiology, Medical College of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Additional Contributors

Juan Carlos Alejos, MD Clinical Professor, Department of Pediatrics, Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine

Juan Carlos Alejos, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Medical Association, International Society for Heart and Lung Transplantation

Disclosure: Received honoraria from Actelion for speaking and teaching.

References
  1. Janik M, Chappell CH, Green TF, Kacharava AG. Two coincident coronary anomalies: absent left main coronary artery and origin of the right coronary artery from the middle left anterior descending artery. Tex Heart Inst J. 2009. 36(2):180-1. [Medline].

  2. Misuraca L, Rutigliano D, Pestrichella V, Contegiacomo G, Balbarini A. A very rare congenital abnormality: double right coronary artery. A case report. J Cardiovasc Med (Hagerstown). 2009 May 18. [Medline].

  3. Lluri G, Aboulhosn J. Coronary arterial development: a review of normal and congenitally anomalous patterns. Clin Cardiol. 2014 Feb. 37(2):126-30. [Medline].

  4. Liu Y, Lu X, Xiang FL, Poelmann RE, Gittenberger-de Groot AC, Robbins J, et al. Nitric oxide synthase-3 deficiency results in hypoplastic coronary arteries and postnatal myocardial infarction. Eur Heart J. 2012 Oct 9. [Medline].

  5. Angelini P, Fairchild VD, eds. Coronary Artery Anomalies: A Comprehensive Approach. Lippincott, Williams & Wilkins; 1999.

  6. Devanagondi R, Brenner J, Vricella L, Ravekes W. A tale of two brothers: anomalous coronary arteries in two siblings. Pediatr Cardiol. 2008 Jul. 29(4):816-9. [Medline].

  7. Brothers JA, Stephens P, Gaynor JW, Lorber R, Vricella LA, Paridon SM. Anomalous aortic origin of a coronary artery with an interarterial course: should family screening be routine?. J Am Coll Cardiol. 2008 May 27. 51(21):2062-4. [Medline].

  8. Tuo G, Marasini M, Brunelli C, Zannini L, Balbi M. Incidence and clinical relevance of primary congenital anomalies of the coronary arteries in children and adults. Cardiol Young. 2013 Jun. 23(3):381-6. [Medline].

  9. Silva J, Costa M, Mota P, Leitao-Marques AM. Myocardial infarction with anomalous coronary anatomy. Rev Port Cardiol. 2009 Feb. 28(2):201-5. [Medline].

  10. Lowry AW, Olabiyi OO, Adachi I, Moodie DS, Knudson JD. Coronary artery anatomy in congenital heart disease. Congenit Heart Dis. 2013 May-Jun. 8(3):187-202. [Medline].

  11. Sim EK, van Son JA, Edwards WD, et al. Coronary artery anatomy in complete transposition of the great arteries. Ann Thorac Surg. 1994. 57(4):890-894. [Medline].

  12. Pasquini L, Parness IA, Colan SD, et al. Diagnosis of intramural coronary artery in transposition of the great arteries using two-dimensional echocardiography. Circulation. 1993 Sep. 88(3):1136-41. [Medline].

  13. Saeed S, Hyder SN, Sadiq M. Anatomical variations of pulmonary artery and associated cardiac defects in Tetralogy of Fallot. J Coll Physicians Surg Pak. 2009 Apr. 19(4):211-4. [Medline].

  14. Sarkar K, Sharma SK, Kini AS. Catheter Selection for Coronary Angiography and Intervention in Anomalous Right Coronary Arteries. J Interv Cardiol. 2009 Apr 2. [Medline].

  15. Saroli T, Gelehrter S, Gomez-Fifer CA, van der Velde ME, Bove EL, Ensing GJ. Anomalies of left coronary artery origin affecting surgical repair of hypoplastic left heart syndrome and Shone complex. Echocardiography. 2008 Aug. 25(7):727-31. [Medline].

  16. Gadhinglajkar S, Sreedhar R. Surgery for anomalous origin of left coronary artery from pulmonary artery: the utility of intraoperative transesophageal echocardiography. Anesth Analg. 2009 May. 108(5):1470-2. [Medline].

  17. Giga V, Dobric M, Beleslin B, Sobic-Saranovic D, Tesic M, Djordjevic-Dikic A, et al. Estimation of infarct size using transthoracic Doppler echocardiographic measurement of coronary flow reserve in infarct related and reference coronary artery. Int J Cardiol. 2012 Oct 8. [Medline].

  18. Falcão SN, Rochitte CE, Junior WM, Quaglia L, Lemos PA, Sbano JC, et al. Incremental Value of Perfusion over Wall-Motion Abnormalities with the Use of Dobutamine-Atropine Stress Myocardial Contrast Echocardiography and Magnetic Resonance Imaging for Detecting Coronary Artery Disease. Echocardiography. 2012 Sep 25. [Medline].

  19. Lytrivi ID, Wong AH, Ko HH, et al. Echocardiographic diagnosis of clinically silent congenital coronary artery anomalies. Int J Cardiol. 2008 Jun 6. 126(3):386-93. [Medline].

  20. Bornemeier RA, Eble BK, Jaquiss RD, Imamura M. Repair of an anomalous left coronary artery from the pulmonary artery in a premature neonate. Congenit Heart Dis. 2008 Nov-Dec. 3(6):435-9. [Medline].

  21. Flynn M, Curtin R, Nowicki ER, et al. Regional wall motion abnormalities and scarring in severe functional ischemic mitral regurgitation: A pilot cardiovascular magnetic resonance imaging study. J Thorac Cardiovasc Surg. 2009 May. 137(5):1063-70.e2. [Medline].

  22. Lederlin M, Thambo JB, Latrabe V, Corneloup O, Cochet H, Montaudon M, et al. Coronary imaging techniques with emphasis on CT and MRI. Pediatr Radiol. 2011 Dec. 41(12):1516-25. [Medline].

  23. Rodriguez-Granillo GA, Rosales MA, Pugliese F, Fernandez-Pereira C, Rodriguez AE. Prevalence and characteristics of major and minor coronary artery anomalies in an adult population assessed by computed tomography coronary angiography. EuroIntervention. 2009 Mar. 4(5):641-7. [Medline].

  24. Ou P, Celermajer DS, Marini D, et al. Safety and accuracy of 64-slice computed tomography coronary angiography in children after the arterial switch operation for transposition of the great arteries. JACC Cardiovasc Imaging. 2008 May. 1(3):331-9. [Medline].

  25. Shepard TF, Srichai MB, Kim D, Lim R, Jacobs JE. Aberrant crossed left circumflex and left anterior descending arteries: diagnosis with multidetector cardiac CT angiography. J Comput Assist Tomogr. 2009 Mar-Apr. 33(2):211-4. [Medline].

  26. Aldana-Sepulveda N, Restrepo CS, Kimura-Hayama E. Single coronary artery: spectrum of imaging findings with multidetector CT. J Cardiovasc Comput Tomogr. 2013 Nov-Dec. 7(6):391-9. [Medline].

  27. Yu FF, Lu B, Gao Y, Hou ZH, Schoepf UJ, Spearman JV, et al. Congenital anomalies of coronary arteries in complex congenital heart disease: diagnosis and analysis with dual-source CT. J Cardiovasc Comput Tomogr. 2013 Nov-Dec. 7(6):383-90. [Medline].

  28. Sithamparanathan S, Padley SP, Rubens MB, Gatzoulis MA, Ho SY, Nicol ED. Great vessel and coronary artery anatomy in transposition and other coronary anomalies: a universal descriptive and alphanumerical sequential classification. JACC Cardiovasc Imaging. 2013 May. 6(5):624-30. [Medline].

  29. Chhatriwalla AK, Prieto LR, Brunken RC, Cerqueira MD, Younoszai A, Jaber WA. Preliminary data on the diagnostic accuracy of rubidium-82 cardiac PET perfusion imaging for the evaluation of ischemia in a pediatric population. Pediatr Cardiol. 2008 Jul. 29(4):732-8. [Medline].

  30. Cohen M, Berger S. The electrocardiogram as an adjunct in diagnosing congenital coronary arterial anomalies. Cardiol Young. 2010 Dec. 20 Suppl 3:59-67. [Medline].

  31. Frobel AK, Hulpke-Wette M, Schmidt KG, Laer S. Beta-blockers for congestive heart failure in children. Cochrane Database Syst Rev. 2009 Jan 21. CD007037. [Medline].

  32. Ginde S, Earing MG, Bartz PJ, Cava JR, Tweddell JS. Late complications after Takeuchi repair of anomalous left coronary artery from the pulmonary artery: case series and review of literature. Pediatr Cardiol. 2012 Oct. 33(7):1115-23. [Medline].

  33. Mainwaring RD, Reddy VM, Reinhartz O, Petrossian E, MacDonald M, Nasirov T, et al. Anomalous aortic origin of a coronary artery: medium-term results after surgical repair in 50 patients. Ann Thorac Surg. 2011 Aug. 92(2):691-7. [Medline].

  34. Jama A, Barsoum M, Bjarnason H, Holmes DR Jr, Rihal CS. Percutaneous closure of congenital coronary artery fistulae: results and angiographic follow-up. JACC Cardiovasc Interv. 2011 Jul. 4(7):814-21. [Medline].

  35. Farouk A, Zahka K, Siwik E, et al. Anomalous origin of the left coronary artery from the right pulmonary artery. J Card Surg. 2009 Jan-Feb. 24(1):49-54. [Medline].

  36. [Guideline] Maron BJ, Thompson PD, Ackerman MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation. 2007 Mar 27. 115(12):1643-455. [Medline]. [Full Text].

  37. Corrado D, Pelliccia A, Heidbuchel H, et al, for the Section of Sports Cardiology, European Association of Cardiovascular Prevention and Rehabilitation. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J. 2010 Jan. 31(2):243-59. [Medline].

  38. Higgins JP, Ananaba IE, Higgins CL. Sudden cardiac death in young athletes: preparticipation screening for underlying cardiovascular abnormalities and approaches to prevention. Phys Sportsmed. 2013 Feb. 41(1):81-93. [Medline].

  39. Yim ES, Basilico F, Corrado G. Early screening for cardiovascular abnormalities with preparticipation echocardiography: utility of focused physician-operated echocardiography in preparticipation screening of athletes. J Ultrasound Med. 2014 Feb. 33(2):307-13. [Medline].

  40. Angelini P. Normal and anomalous coronary arteries: definitions and classification. Am Heart J. 1989 Feb. 117(2):418-34. [Medline].

  41. Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol. 2000 May. 35(6):1493-501. [Medline].

  42. Burch GH, Sahn DJ. Congenital coronary artery anomalies: the pediatric perspective. Coron Artery Dis. 2001 Dec. 12(8):605-16. [Medline].

  43. Coudrey L. The troponins. Arch Intern Med. 1998 Jun 8. 158(11):1173-80. [Medline].

  44. Davis JA, Cecchin F, Jones TK, Portman MA. Major coronary artery anomalies in a pediatric population: incidence and clinical importance. J Am Coll Cardiol. 2001 Feb. 37(2):593-7. [Medline].

  45. Gould KL. Coronary Artery Stenosis. New York, NY: Elsevier Science Publishers; 1991. 7-71.

  46. Hanley FL, Sade RM, Blackstone EH, et al. Outcomes in neonatal pulmonary atresia with intact ventricular septum. A multiinstitutional study. J Thorac Cardiovasc Surg. 1993 Mar. 105(3):406-23, 424-7; discussion 423-4. [Medline].

  47. Jaquiss RD, Tweddell JS, Litwin SB. Surgical therapy for sudden cardiac death in children. Pediatr Clin North Am. 2004 Oct. 51(5):1389-400. [Medline].

  48. Kirklin JW, Barratt-Boyes BG. Congenital anomalies of the coronary arteries in Cardiac Surgery. 2nd ed. New York, NY: Churchill Livingstone; 1992.

  49. Liberthson RR. Sudden death from cardiac causes in children and young adults. N Engl J Med. 1996 Apr 18. 334(16):1039-44. [Medline].

  50. Manghat NE, Morgan-Hughes GJ, Marshall AJ, Roobottom CA. Multidetector row computed tomography: imaging congenital coronary artery anomalies in adults. Heart. 2005 Dec. 91(12):1515-22. [Medline].

  51. Memisoglu E, Hobikoglu G, Tepe MS. Congenital coronary anomalies in adults: comparison of anatomic course visualization by catheter angiography and electron beam CT. Catheter Cardiovasc Interv. 2005 Sep. 66(1):34-42. [Medline].

  52. Rigatelli G, Rigatelli G. Coronary artery anomalies: what we know and what we have to learn. Aproposal for a new clinical classification. Ital Heart J. 2003 May. 4(5):305-10. [Medline].

  53. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn. 1990 Sep. 21(1):28-40. [Medline].

Previous
Next
 
Incidence of coronary artery abnormalities detected in 1,950 selective coronary angiograms performed in adult patients with suspected coronary arterial obstructive disease and otherwise anatomically normal hearts.
Normal anatomy of coronary arteries, viewed from above with the atria removed. A = aortic valve; P = pulmonary valve; T = tricuspid valve; M = mitral valve; RCA = right coronary artery; AM = acute marginal branch of the right coronary artery; CB = conus branch of the right coronary artery; PD = posterior descending branch; AVN = atrioventricular nodal branch; Circ = circumflex coronary artery; OM = obtuse marginal branches of circumflex coronary artery; LAD = left anterior descending coronary artery; Diag = diagonal branches of the left anterior descending coronary artery; Inter = intermedius branch of the left coronary artery.
Thirteen patterns of origin and proximal epicardial course of coronary arteries in 255 hearts with complete transposition of the great arteries. LAD = left anterior descending coronary artery; LCA = left coronary artery; LCx = left circumflex coronary artery; RCA = right coronary artery. (Image courtesy of Excerpta Medica, Inc).
MRI of anomalous right coronary artery (RCA = black arrow) arising from the left sinus of Valsalva and coursing interatrially between the aorta (AO) and the pulmonary artery (PA). Note the oblique origin and the intramural course within the aortic wall, all factors compromising coronary blood flow.
Three-dimensional volume rendering from multidetector CT imaging of a large right coronary artery aneurysm (arrow). Subtraction of the myocardium in B shows the fistula draining to the coronary sinus and then into the right atrium. (Reproduced from Manghat NE, Morgan-Hughes GJ, Marshall AJ, Roobottom CA: Multidetector row computed tomography: imaging congenital coronary artery anomalies in adults. Heart 2005 Dec; 91(12): 1515-22).
Selective right coronary arterial injection in an 8-month-old female with tetralogy of Fallot malformation. Study demonstrates left anterior descending coronary artery (LAD) arising early from the right coronary artery (RCA) and coursing across the right ventricular outflow tract. Left anterior oblique projection.
Operative repair of anomalous left coronary artery (LCA) from the right sinus of Valsalva. The slitlike anomalous origin of the left coronary artery from the right aortic sinus of Valsalva is demonstrated, as is the intramural course of the coronary artery. (B) The intramural course of the artery is unroofed, placing the functional ostium in the left sinus. (C) Tacking sutures are used to secure the intima of the new coronary ostium and to reinforce the adjacent commissure of the aortic valve. (Reproduced from Jaquiss RD, Tweddell JS, Litwin SB: Surgical therapy for sudden cardiac death in children. Pediatr Clin North Am 2004 Oct; 51(5): 1389-400).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.