eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Coronary Artery Anomalies: Multimedia

Author: Andrew N Pelech, MD, Professor, Department of Pediatrics, Medical College of Wisconsin; Director of Cardiac Catheterization Laboratory, Cardiology Research Focus and Cardiology Database, Director of Herma Heart Center Clinical Research, Children's Hospital of Wisconsin; Chairman of Wisconsin Pediatric Cardiac Registry
Contributor Information and Disclosures

Updated: Jun 1, 2009

Multimedia

Incidence of coronary artery abnormalities detect...Media file 1: 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.
Incidence of coronary artery abnormalities detect...

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 ...Media file 2: 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.
Normal anatomy of coronary arteries, viewed from ...

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 epicardi...Media file 3: 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).
Thirteen patterns of origin and proximal epicardi...

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 = bla...Media file 4: 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.
MRI of anomalous right coronary artery (RCA = bla...

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 multidete...Media file 5: 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).
Three-dimensional volume rendering from multidete...

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...Media file 6: 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.
Selective right coronary arterial injection in an...

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 arter...Media file 7: 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).
Operative repair of anomalous left coronary arter...

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).

More on Coronary Artery Anomalies

Overview: Coronary Artery Anomalies
Differential Diagnoses & Workup: Coronary Artery Anomalies
Treatment & Medication: Coronary Artery Anomalies
Follow-up: Coronary Artery Anomalies
Multimedia: Coronary Artery Anomalies
References
Further Reading

References

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  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). May 18 2009;[Medline].

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

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

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

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Keywords

coronary artery malformations, abnormalities of the coronary vasculature, coronary artery anomalies, right coronary artery, RCA, left coronary artery, LCA, left anterior descending artery, circumflex artery, LAD, Cx, coronary ostia, coronary artery disease, CAD, myocardial ischemia, sudden death, myocardial dysfunction, angina, syncope, dysrhythmia, congestive heart failure, CHF, failure to thrive, ostial stenosis, coronary ischemia, coronary artery fistula, endocarditis, elfin facies, infantile hypercalcemia, hypoplastic teeth, transposition of the great arteries, tetralogy of Fallot, pulmonary atresia, left ventricular outflow tract obstruction, mitral valve insufficiency, treatment, diagnosis

Contributor Information and Disclosures

Author

Andrew N Pelech, MD, Professor, Department of Pediatrics, Medical College of Wisconsin; Director of Cardiac Catheterization Laboratory, Cardiology Research Focus and Cardiology Database, Director of Herma Heart Center Clinical Research, Children's Hospital of Wisconsin; Chairman of Wisconsin Pediatric Cardiac Registry
Disclosure: Nothing to disclose.

Medical Editor

Juan Carlos Alejos, MD, Clinical Professor, Department of Pediatrics, Division of Cardiology, University of California at Los Angeles
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, and International Society for Heart and Lung Transplantation
Disclosure: Actelion Honoraria Speaking and teaching

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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
Disclosure: Nothing to disclose.

CME Editor

Gilbert Z Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center
Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Steven R Neish, MD, SM, Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine
Steven R Neish, MD, SM is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Heart Association
Disclosure: Nothing to disclose.

 
 
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