Echocardiographic imaging of anomalous origin of the coronary arteries

2010 ◽  
Vol 20 (S3) ◽  
pp. 26-34 ◽  
Author(s):  
Meryl S. Cohen ◽  
René J. Herlong ◽  
Norman H. Silverman
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Left Ventricular ◽  
Pulmonary Trunk ◽  
Anomalous Origin ◽  
Ventricular Performance ◽  
Non Invasive ◽  
Left Ventricular Dilation ◽  
Definition Of ◽  
Anomalous Coronary

AbstractIn the past, coronary arterial anomalies have been difficult to diagnose by non-invasive methods. Identification of coronary arterial origins is now a routine part of the standard paediatric echocardiogram. Anomalous origin of a coronary artery from the pulmonary trunk is an extremely important diagnosis to make. Many echocardiographic features are not directly related to the visualisation of the coronary arterial origin. Left ventricular dilation and abnormal ventricular performance are common, along with mitral regurgitation and evidence of collateralisation of the flow from the coronary artery that has an aortic origin. In some cases, the anomalous coronary artery can be seen to arise directly from the pulmonary trunk. Congenital atresia of the main stem of the left coronary artery has a similar echocardiographic presentation, except that its aortic origin is not determined. Anomalous aortic origin of the coronary artery has important implications, as the first presenting symptom can be sudden death. With meticulous attention to the origins of the coronary arteries, echocardiographic diagnosis can also be achieved. In contrast to the anomalous origin of a coronary artery from the pulmonary trunk, ventricular performance is usually normal. Whenever there is doubt as to the definition of the origin of the coronary arteries and, indeed, when there is serious clinical concern that a coronary artery has an anomalous origin, other testing, such as cine-computed tomography, magnetic resonance imaging, or cardiac catheterisation may be indicated for confirmation or to provide greater anatomic detail.

Identification, imaging, functional assessment and management of congenital coronary arterial abnormalities in children

2007 ◽  
Vol 17 (S4) ◽  
pp. 56-67 ◽  
Author(s):  
Alan H. Friedman ◽  
Mark A. Fogel ◽  
Paul Stephens ◽  
Jeffrey C. Hellinger ◽  
David G. Nykanen ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Right Coronary Artery ◽  
Functional Assessment ◽  
Left Coronary Artery ◽  
Left Ventricular ◽  
Pulmonary Trunk ◽  
Anomalous Origin ◽  
Sinus Of Valsalva ◽  
The Right

AbstractThe coronary arteries, the vessels through which both substrate and oxygen are provided to the cardiac muscle, normally arise from paired stems, right and left, each arising from a separate and distinct sinus of the aortic valve. The right coronary artery runs through the right atrioventricular groove, terminating in the majority of instances in the inferior interventricular groove. The main stem of the left coronary artery bifurcates into the anterior descending, or interventricular, and the circumflex branches. Origin of the anterior descending and circumflex arteries from separate orifices from the left sinus of Valsalva occurs in about 1% of the population, while it is also frequent to find the infundibular artery arising as a separate branch from the right sinus of Valsalva.Anomalies of the coronary arteries can result from rudimentary persistence of an embryologic coronary arterial structure, failure of normal development or normal atrophy as part of development, or misplacement of connection of a an otherwise normal coronary artery. Anomalies, therefore, can be summarized in terms of abnormal origin or course, abnormal number of coronary arteries, lack of patency of the orifice of coronary artery, or abnormal connections of the arteries.Anomalous origin of the left coronary artery from the pulmonary trunk occurs with an incidence of approximately 1 in 300,000 children. The degree of left ventricular dysfunction produced likely relates to the development of collateral vessels that arise from the right coronary artery, and provide flow into the left system. Anomalous origin of either the right or the left coronary artery from the opposite sinus of Valsalva can be relatively innocuous, but if the anomalous artery takes an interarterial course between the pulmonary trunk and the aorta, this can underlie sudden death, almost invariably during or immediately following strenuous exercise or competitive sporting events. Distal anomalies of the coronary arteries most commonly involve abnormal connections, or fistulas, between the right or left coronary arterial systems and a chamber or vessel.We discuss the current techniques available for imaging these various lesions, along with their functional assessment, concluding with a summary of current strategies for management.

ANOMALOUS ORIGIN OF THE LEFT CORONARY ARTERY FROM THE PULMONARY ARTERY (ADULT TYPE)

PEDIATRICS ◽  
1962 ◽  
Vol 29 (2) ◽  
pp. 274-282
Author(s):  
M. H. Agustsson ◽  
B. M. Gasul ◽  
R. Lundquist
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Left Coronary Artery ◽  
Clinical Findings ◽  
Left Ventricular ◽  
Anomalous Origin ◽  
White Female ◽  
Adult Type ◽  
Anomalous Coronary ◽  
Anomalous Left Coronary

The case of a 7-year-old white female with an anomalous left coronary artery from the pulmonary artery is presented. The clinical findings of an asymptomatic patient with a continuous murmur at the left lower strenal border, with left ventricular hypertrophy by roentgenography and electrocardiography raised the suspicion of an aortic fistula, which was then investigated by retrograde aortography. The aortogram demonstrated the anomalous origin of the left coronary artery with retrograde flow into the pulmonary artery. The age and circumstances of death in previously reported cases indicate that the so-called adult type is not a benign disease. The diagnosis of an anomalous coronary artery from the pulmonary artery is at any age an indication for consideration of surgical intervention.

Towards an anatomically correct repair for anomalous left coronary artery arising from the pulmonary trunk

2008 ◽  
Vol 18 (4) ◽  
pp. 372-378 ◽  
Author(s):  
M. Muneer Amanullah ◽  
Anthony J. Rostron ◽  
J. R. Leslie Hamilton ◽  
Milind P. Chaudhari ◽  
Asif Hasan
Keyword(s):  
Coronary Artery ◽  
Left Coronary Artery ◽  
Surgical Techniques ◽  
Left Ventricular ◽  
Pulmonary Trunk ◽  
Anomalous Origin ◽  
Cardiac Transplant ◽  
Anomalous Left Coronary Artery ◽  
Term Outcome ◽  
Anomalous Left Coronary

AbstractBackgroundAnomalous origin of the left coronary artery from the pulmonary trunk is rare, occurring at an incidence of 1 in 300 000. If not diagnosed and treated early, it is life-threatening. Children with the anomaly usually present in infancy with congestive cardiac failure, and are occasionally referred for cardiac transplant. We investigated the medium term outcome for patients following creation of a two-coronary arterial circulation.MethodsBetween 1992 and 2007, we diagnosed 15 patients seen at our Institution as having anomalous origin of the left coronary artery from the pulmonary trunk. Over a period of 13 years, aortic reimplantation was undertaken in 12 of these patients, who form the studied cohort.ResultsDirect reimplantation was performed in 5 patients. In 3 cases, a tension-free anastomosis was created using a caudally based flap. In another 3 cases, an extended flap was used, while a patch arterioplasty was fashioned in the final patient. There were no deaths. Left ventricular function recovered in all but one of the patients, and all patients had a reduction in the degree of mitral regurgitation.ConclusionsAmong the variety of surgical techniques, transfer of the anomalous left coronary artery to the aorta is the ideal method for long-term patency and adequate blood supply. This can be achieved by creating flaps based on the walls of the pulmonary trunk and aorta, producing a dual coronary arterial supply with no mortality and low morbidity.

scholarly journals Right Anomalous Coronary Artery Origin: The Role of Multislice CT Angiography

2016 ◽  
pp. 274-7
Author(s):  
Isyana M Kurniawan ◽  
Elen Elen ◽  
Celly A Atmadikoesoemah ◽  
Manoefris Kasim
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Multislice Ct ◽  
Ct Coronary Angiography ◽  
Pulmonary Trunk ◽  
Anomalous Coronary Artery ◽  
Coronary Artery Anomalies ◽  
Non Invasive ◽  
Anomalous Coronary ◽  
Typical Chest Pain

Introduction: The anomalous origin of the right coronary artery (RCA) from the left coronary sinus coursing between the aorta and the pulmonary trunk is rare, but may cause myocardial ischemia and sudden death. Multislice CT coronaryangiography offers the possibility to visualize anomalous coronary artery origin non-invasively in details.Case Illustration: A 54-year-old man with a history of arterial hypertension, and hypercholesterolemia began to present with typical chest pain. After some non-invasive examination, he had coronary angiographythat revealed 70% stenosis at mid intermediate artery, normalLMCA, LAD and LCX. Ostium of RCA was found near the left valsava sinus afterrepeated cannulation attempts, no stenosis was found at RCA. After successful revascularization at intermediate artery, patient still had typical chest pain with positive ischemic response in treadmill test. Multislice CT coronary angiography was performedto evaluate the etiology of chest pain. The scan showed patent stent at intermediate artery and anomalous RCA origin from the left coronary sinus withacute angle take-off, luminal narrowing of the osteal-proximal part, as well as luminal compression between the ascending aorta and the pulmonary trunk (an interarterial course) while RCA appeared as dominant vessel. These features were considered as malignant coronary anomaly that could lead to the recommendation of surgical correction.Discussion: Accurate recognition and documentation of coronary artery anomalies are essential to determine the significance of such findings and to avoid furtherclinical complications. Multislice CT coronary angiography is a non-invasive imaging modality that can easily and precisely depict the origin and course of coronary artery anomalies as well as its relationship with adjacent structures.

Surgery and critical care for anomalous coronary artery from the pulmonary artery

2010 ◽  
Vol 20 (S3) ◽  
pp. 35-43 ◽  
Author(s):  
Timothy A. Fehrenbacher ◽  
Michael E. Mitchell ◽  
Nancy S. Ghanayem ◽  
James S. Tweddell
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Left Coronary Artery ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Arterial System ◽  
Anomalous Origin ◽  
Anomalous Coronary Artery ◽  
Young Infants ◽  
Anomalous Coronary

AbstractAnomalous origin of the left coronary artery from the pulmonary artery is a rare congenital cardiac malformation that accounts for 0.25–0.50% of children with congenital cardiac disease and can cause myocardial dysfunction in young infants. In any infant presenting with ventricular dysfunction, the diagnosis of anomalous origin of the left coronary artery from the pulmonary artery must be suspected and the origin of the coronary arteries must be confirmed. The diagnosis of anomalous origin of the left coronary artery from the pulmonary artery is an indication for surgical repair. A two-coronary arterial system is the goal and is almost always achievable. The goal of surgical therapy is the creation of a two-coronary arterial system, which appears to provide better long-term survival and protection from left ventricular dysfunction and mitral valvar regurgitation than does simple ligation of the anomalous coronary artery. Direct reimplantation of the anomalous coronary artery is the procedure of choice. It is straightforward and borrows from well-practised techniques commonly used in other procedures such as the arterial switch operation. For the rare patient in whom direct reimplantation is not possible, strategies to lengthen the anomalous coronary artery, or baffle it within the pulmonary root, are available. Mitral valvar regurgitation is common at presentation, but following the establishment of a two-coronary arterial system and satisfactory myocardial perfusion, regurgitation of the mitral valve resolves in the vast majority. Therefore, mitral valvuloplasty at the time of initial surgery for anomalous origin of the left coronary artery from the pulmonary artery is not indicated. Post-operative care requires careful manipulation of inotropic support and reduction of afterload. Mechanical support, with either extracorporeal membrane oxygenation or left ventricular assist device, should be available for use if necessary.

scholarly journals Anomalous origin of coronary arteries with an interarterial course: pictorial essay

2019 ◽  
Vol 52 (3) ◽  
pp. 193-197
Author(s):  
Ana Flávia Pina Ferreira ◽  
Sharon Rosemberg ◽  
Daniel Simões Oliveira ◽  
José de Arimatéia Batista Araujo-Filho ◽  
Cesar Higa Nomura
Keyword(s):  
Coronary Artery ◽  
Ct Angiography ◽  
Coronary Arteries ◽  
Pulmonary Valve ◽  
Ascending Aorta ◽  
Pulmonary Trunk ◽  
Anomalous Origin ◽  
Pictorial Essay ◽  
High Resolution Images ◽  
The Right

Abstract Coronary arteries originating from the contralateral (noncoronary) sinus and having an interarterial course, in which they run from the ascending aorta to the pulmonary trunk, is a potentially fatal anomaly. Computed tomography (CT) angiography facilitates the recognition and therapeutic planning of such anomalies because of its ability to acquire high-resolution images of the entire course of the coronary artery, as well as of the accompanying atherosclerotic involvement. The right coronary artery originating from the left coronary sinus is the most prevalent anomaly of this type and usually implies a better prognosis, the interarterial course being classified as "high" or "low", depending on whether it is above or below the level of the pulmonary valve, with consequent stratification of the risk and the treatment. However, it is known that there is a high risk of sudden death among patients with a left coronary artery of anomalous origin from the right sinus. In such cases, surgical treatment is recommended, regardless of whether there are symptoms or evidence of ischemia. Given the importance of those aspects, which can be identified on CT of the chest or CT angiography of the aorta, this pictorial essay aims to illustrate such anomalies to facilitate their recognition and description by radiologists who are not specialists in cardiac imaging.

Anomalous origin and course of the coronary arteries

2010 ◽  
Vol 20 (S3) ◽  
pp. 20-25 ◽  
Author(s):  
Anthony Hlavacek ◽  
Marios Loukas ◽  
Diane Spicer ◽  
Robert H. Anderson
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Right Coronary Artery ◽  
Left Coronary Artery ◽  
Pulmonary Trunk ◽  
Main Stem ◽  
Anomalous Origin ◽  
Aortic Sinus ◽  
Atrioventricular Groove ◽  
The Right

AbstractIn the normal heart, the right and left coronary arteries arise from the aortic valvar sinuses adjacent to the pulmonary trunk. The right coronary artery then directly enters the right atrioventricular groove, whereas the main stem of the left coronary artery runs a short course before dividing to become the anterior interventricular and circumflex arteries. These arteries can have an anomalous origin from either the aorta or pulmonary trunk; their branches can have various anomalous origins relative to arterial pedicles. Other abnormal situations include myocardial bridging, abnormal communications, solitary coronary arteries, and duplicated arteries. Understanding of these variations is key to determining those anomalous patterns associated with sudden cardiac death. In the most common variant of an anomalous origin from the pulmonary trunk, the main stem of the left coronary artery arises from the sinus of the pulmonary trunk adjacent to the anticipated left coronary arterial aortic sinus. The artery can, however, arise from a pulmonary artery, or the right coronary artery can have an anomalous pulmonary origin. The key feature in the anomalous aortic origin is the potential for squeezing of the artery, produced by either the so-called intramural origin from the aorta, or the passage of the abnormal artery between the aortic root and the subpulmonary infundibulum.

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