The incidence and pattern of coronary artery anomalies in the north-west of iran: a coronary arteriographic study

Abstract

Background and objectives: Coronary artery anomalies are found in approximately 1% of patients undergoing diagnostic coronary angiography (CAG). Angiographic recognition of these vessels is important because of their clinical significance and importance in patients undergoing coronary angioplasty or cardiac surgery. There are fairly enough reports concerning the incidence of coronary anomalies in different geographic areas, but this is the first study among the Iranian population.

Subjects and methods: We reviewed the database of the Catheterization Laboratory of Imam Reza and Shahid Madani Hospitals, Tabriz University of Medical Sciences, Iran. Our inquiry included all patients who referred for CAG from other hospitals, between February 2007 and April 2009. Patients with congenital heart diseases, high "take off" of coronary arteries and separate origin of the conus artery from the right coronary sinus (RCS) were excluded. In total, 6065 films were reviewed.

Results: Seventy nine (1.30%) patients were found to have coronary anomalies. Seventy five (1.24%) patients had anomalies of origin and distribution, while four (0.06%) had coronary artery fistulae. Most common anomaly was separate ostia of the left anterior descending artery and left circumflex artery, which was found in 42 patients (53.16%) with angiographic incidence of 0.69%. The next most common anomalies were anomalous circumflex artery from RCS/right coronary artery (RCA) {n=17 (21.51%)}, and anomalous RCA arising from left coronary sinus {n=6 (7.59%)}.

Conclusion: In general, the incidence and pattern of coronary anomalies in our study was similar to earlier reports from different parts of the world.

Keywords: Accept; Angiography; Coronary arteries.

Fig. 1

Seperated LAD & LCX. Separate origins of LAD and LCX from the left coronary sinus. LAD: left anterior descending artery, LCX: left circumflex artery.

Fig. 2

Anomalous circumflex artery from the right coronary sinus (RCS)/right coronary artery. A: in one patient, left circumflex artery originates from right coronary sinus with significant coronary artery disease (arrow=lesion). B: another patient also had separate origins of conus artery and concomitant severe aortic regurgitation.

Fig. 3

RCA arising from LCS. RCA is originating from an orifice located anterior to LMCA ostium in the LCS and had interarterial course before reaching the right atrioventricular groove. RCA: right coronary artery, LCS: left coronary sinus, MLCA: left main coronary artery.

Fig. 4

LMCA arising from right coronary sinus. A: in this patient LMCA courses between aorta and pulmonary artery. B: a patient with anomalous LMCA with septal course. LMCA: left main coronary artery.

Fig. 5

Single coronary artery. Type I single coronary artery: the territory of right coronary artery is supplied by the continuation of left circumflex artery artery. A and B are different views of one patient and C, D and E are different views of another patient.

Fig. 6

Separated 3 coronary arteries. All 3 coronary arteries arising from right coronary sinus with separate osita. Distribution is normal. A: left anterior descending artery is diminutive and does not reach the apex and has septal course of its proximal part. B: circumflex artery originates from separate ostia and courses behind the aorta.

Fig. 7

Anomalous LCA from pulmonary artery. LCA is arising from pulmonary artery and was filing retrogradely via RCA. Both coronary arteries are enlarged, especially RCA. LCA: Left coronary artery, RCA: right coronary artery.

Fig. 8

Divided left circumflex artery. A: large obtuse marginalis, arising from left coronary artery. B: Aberrant circumflex artery from right coronary sinus.