Coronary artery anomalies: Role of contrast enhanced MDCT coronary angiography

Purpose.Until the mid-20th century they could be discovered only during autopsy, it means after death. With the introduction of coronary angiography it become possible to find them in a living person. Later on, new modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) enhanced futher our abilities. It is very important to discover coronary anomalies in a living person, because some of them could lead to sudden cardiac death (SCD). In fact, coronary artery anomalies are the second main cause of the SCD in young athletes. Another importance is driven by the fact, that some of them could lead to lifethreatening complications during cardiac surgery when unknown before the operation.Methods.We prospectively reviewed all coronary angiography films from 2011 to 2016 in our center. Coronary anomalies were reviewed and classified by two independent experienced operators. Patients with congenital heart disease and coronary fistulas were excluded.Results.Out of 5055 patients 148 (2.9%) had coronary artery anomalies of origin and distribution. Those were 120 men (81.1%) and 28 women (18.9%) with an age range between 29 to 88 years. The three most common anomalies were myocardial bridge (48.7%), separate origin of the conus branch (13.5%) and separate origin of the LAD and LCX (8.1%).Conclusion.In our study we found more or less the same types and incidence rates of coronary artery anomalies as in the world literature. We had apparently higher rates of myocardial bridges, compared to average number on angiography studies, but very close to authopsy study rates.

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Coronary artery anomalies in adults: Imaging at dual source CT coronary angiography

Journal of Medical Imaging and Radiation Oncology ◽

10.1111/j.1754-9485.2012.02428.x ◽

2012 ◽

Vol 57 (2) ◽

pp. 184-190 ◽

Cited By ~ 4

Author(s):

Fotios Laspas ◽

Arkadios Roussakis ◽

Christos Mourmouris ◽

Nikolaos Kritikos ◽

Roxani Efthimiadou ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Ct Coronary Angiography ◽

Dual Source Ct ◽

Coronary Artery Anomalies ◽

Dual Source

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The Emerging Role of 64-Slice Multidetector Computed Tomography (MDCT) Coronary Angiography in Risk Stratification of Patients with Low (<50) or Zero Calcium Scores

Heart Lung and Circulation ◽

10.1016/j.hlc.2007.06.079 ◽

2007 ◽

Vol 16 ◽

pp. S30

Author(s):

C. Arronis ◽

S. Eggleton ◽

D. Friedman ◽

J. Lambros ◽

O. Moukhallalati ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Angiography ◽

Risk Stratification ◽

Multidetector Computed Tomography ◽

Mdct Coronary Angiography

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Abstract 2594: Coronary Multidetector Computed Tomography in the Prognostic Assessment of Patients with Equivocal or Mildly Abnormal Non-Invasive Cardiac Stress Tests

Circulation ◽

10.1161/circ.116.suppl_16.ii_574-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Clerio Azevedo ◽

Mariane Spotti ◽

Sabrina Bezerra ◽

Marcelo Hadlich ◽

Humberto Villacorta ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Coronary Angiography ◽

Confidence Interval ◽

Coronary Stenosis ◽

Atherosclerotic Plaques ◽

Stress Tests ◽

Cardiac Stress ◽

Non Invasive ◽

Mdct Coronary Angiography

Background: Patients with low or moderate pre-test probability of significant coronary artery disease (CAD) and equivocal or mildly abnormal non-invasive cardiac stress tests represent a frequent management challenge. Coronary multidetector computed tomography (MDCT) has been shown to have excellent diagnostic accuracy to exclude the presence of significant CAD. Methods: The study included 218 patients (mean age 59±12 years, 60% male) with equivocal or mildly abnormal exercise electrocardiography (n=93), stress SPECT perfusion scans (n=121), stress echocardiography (n=3) and stress cardiac MRI (n=1). Patients were either asymptomatic (n=113) or had atypical chest pain (n=105). All patients underwent contrast-enhanced 64-slice MDCT coronary angiography and datasets were evaluated for the presence of coronary atherosclerotic plaques and significant coronary artery stenosis. Patients were followed for 8±3 months and the endpoints evaluated were: cardiac death, myocardial infarction, revascularization procedure performed >3 months after MDCT coronary angiography and unstable angina requiring hospitalization. Results: MDCT coronary angiography was either normal (n=90; 41%), demonstrated non-obstructive coronary atherosclerotic plaques (n=66; 30%) or exhibited significant coronary stenosis (n=62; 29%). Event-free survival was 100% for patients with normal coronary angiography, 98% for patients with non-obstructive plaques and 92% for patients with coronary stenosis (log-rank test P=0.01). One patient with a non-obstructive plaque involving the left main coronary artery died following an AMI (hazard ratio, 0.38; 95% confidence interval, 0.04 to 3.24). Among patients with coronary stenosis, 3 underwent revascularization procedures and 2 died (hazard ratio, 12.59; 95% confidence interval, 1.47 to 107.86). Conclusion: Among patients with equivocal or mildly abnormal non-invasive cardiac stress tests, a normal MDCT coronary angiography is associated with a very low risk for subsequent cardiac events. Further studies are necessary to determine the clinical significance of non-obstructive atherosclerotic plaques detected by MDCT coronary angiography in this patient population.

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