Prevalence and characteristics of coronary artery anomalies in an adult population undergoing multidetector-row computed tomography for the evaluation of coronary artery disease

Abstract

Background: Congenital coronary anomalies are uncommon with an incidence ranging from 0.17 % in autopsy cases to 1.2 % in angiographically evaluated cases. The recent development of ECG-gated multi-detector row computed tomography (MDCT) coronary angiography allows accurate and noninvasive depiction of coronary artery anomalies.

Methods: This retrospective study included 2572 patients who underwent coronary 64-slice MDCT coronary angiography from January 2008 to March 2012. Coronary angiographic scans were obtained with injection of 80 ml nonionic contrast medium. Retrospective gating technique was used to synchronize data reconstruction with the ECG signal. Maximum intensity projection, multi-planar reformatted, and volume rendering images were derived from axial scans.

Results: Of the 2572 patients, sixty (2.33 %) were diagnosed with coronary artery anomalies (CAAs), with a mean age of 53.6 ± 11.8 years (range 29-80 years). High take-off of the RCA was seen in 16 patients (0.62 %), of the left main coronary artery (LMCA) in 2 patients (0.08 %) and both of them in 2 patients (0.08 %). Separate origin of the left anterior descending artery (LAD) and left circumflex artery (LCx) from left sinus of Valsalva (LSV) was found in 15 patients (an incidence of 0.58 %). In 9 patients (0.35 %) the right coronary artery (RCA) arose from the opposite sinus of Valsalva with a separate ostium. In 6 patients (0.23 %) an abnormal origin of LCX from the right sinus of Valsalva (RSV) was found with a further posterior course within the atrioventricular groove. A single coronary artery was seen in 3 patients (0.12 %). It originated from the right sinus of Valsalva in one patient and from LSV in two patients. In two other patients (0.08 %) the left coronary trunk originated from the RSV with separate ostium from the RCA. LCA originating from the pulmonary artery was found in one patient (0.04 %). A coronary artery fistula, which is a termination anomaly, was detected in 4 patients (0.15 %).

Discussion: Although these anomalies, which are remarkably different from the normal structure, exist as early as birth, they are incidentally encountered during selective angiography or at autopsy. The incidence in reported angiographic series ranges from 0.6 % to 1.3 %. Variations in the frequency of primary congenital coronary anomalies may possibly have a genetic background. The largest angiographic series of 126595 patients, by Yamanaka and Hobbs, reported a 1.3 % incidence of anomalous coronary artery.

Conclusion: The results of this study support the use MDCT coronary angiography as a safe and effective noninvasive imaging modality for defining CAAs in an appropriate clinical setting, providing detailed three-dimensional anatomic information that may be difficult to obtain with invasive angiography.

Fig. 1

Volume-rendered image show high take-off of the right coronary artery (RCA) above the sinotubular junction

Fig. 2

Volume-rendered images show the absence of the left main coronary artery, with separate ostia of the LAD and LCX arteries from the left sinus of Valsalva (LSV). A = aorta

Fig. 3

Three-dimensional volume-rendered image shows the RCA arising from the left coronary sinus and with a malignant inter-arterial course between the pulmonary artery (PA) and the aorta (Ao)

Fig. 4

A patient with a left circumflex artery (LCX) anomalous origin. Three-dimensional volume-rendered image shows the LCX arising separately close to the origin of the right coronary artery (RCA) from the right coronary sinus and coursing below and behind the aortic root

Fig. 5

A patient with a single coronary artery originating from the right sinus of Valsalva. a Axial image demonstrating the left main coronary artery travelling between the aorta (AO) and the right ventricular outflow tract (b). Cardiac transparency image shows the anomalous origin of the LM, its course and the detailed anatomic relationship

Fig. 6

A patient with a single coronary artery. Volume-rendered and cardiac transparency images reveals a SCA arising from the left sinus of Valsalva and gives off the left anterior descending (LAD) and circumflex (LCx) branches. The right coronary artery ostium was congenitally absent (Panel A). The LCx is markedly dominant and continues beyond the crux into the atrioventricular groove and provides branches to the right ventricle and atrium (Panel B)

Fig. 7

3-D volume-rendered images of the coronary tree showing a single coronary artery arising from the left coronary sinus, where the left main artery (LM) gives rise to the right coronary artery (RCA) as shown by the black arrow. The RCA runs a malignant course between the pulmonary artery (PA) and the aorta

Fig. 8

3-D Volume-rendered images, shows the entire coronary system originating from right sinus of Valsalva from three separate ostia. Left anterior descending coronary artery passes anterior to the right ventricular outflow tract. Circumflex artery passes posteriorly between the left atrium and the aortic root to resume its normal position in left atrioventricular groove. The Right coronary artery has normal configuration

Fig. 9

A patient with anomalous origin of the left coronary system from the right coronary cusp (separate ostium). 3-D volume-rendered and images show the anomalous origin of the LM, its course and the detailed anatomic relationship

Fig. 10

Three-dimensional volume-rendered image shows the dilated RCA from the aorta (Ao), the anomalous origin of the LMCA from pulmonary artery (PA), along with their anatomical relationship with surrounding structures. Rich collateral channels between RCA and LCA are shown

Fig. 11

3-D volume rendering images showing the coronary fistula located between the left anterior descending (LAD) artery and the pulmonary artery