Anomalous origin of the right coronary artery with interarterial course: a mid-term follow-up of 28 cases

Abstract

Anomalous origin of the right coronary artery from the opposite sinus (right-ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomography angiography (CCTA) has led to increased recognition of this condition, even among healthy individuals. Our study sought to examine the prevalence, anatomical characteristics, and outcomes of right-ACAOS with IAC in patients undergoing CCTA for suspected coronary artery disease (CAD). We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital from January 2012 to December 2020. Patients exhibiting right-ACAOS with IAC were analyzed for cardiac symptoms and mid-term occurrence of first MACE (cardiac death, SCD, non-fatal myocardial infarction (MI) or revascularization of the anomalous vessel). CCTAs were reviewed for anatomical high-risk features and concomitant CAD. Among 10,928 patients referred for CCTA, 28 patients with right-ACAOS with IAC were identified. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented stable cardiac symptoms. Most patients had at least one high risk anatomical feature. During follow-up, there were no cardiac deaths or aborted SCD episodes and only 1 patient underwent surgical revascularization of the anomalous vessel. Right-ACAOS with IAC is an uncommon finding (prevalence of 0.26%). In a contemporary population of predominantly asymptomatic patients who survived this condition well into adulthood, most patients were managed conservatively with a low event rate. Additional studies are needed to support medical follow-up as the preferred option in this setting.

Figure 1

Study design. ACAOS  anomalous origin of the coronary artery arising from the opposite sinus; CCTA  coronary computed tomography angiography; IAC interarterial course.

Figure 2

High risk anatomic features of right-ACAOS with IAC on CCTA—CCTA-identified right-ACAOS features. (1) 3D image depicting anomalous origin of the coronary artery arising from the opposite sinus with interarterial course between aorta and pulmonary artery. (2) Intramural location and take-off angles obtained in multiplanar axial reconstructions at the level of the ACAOS ostium. (3) Slit-dlike morphology. Lumen diameters obtained in double oblique view, taking the maximum and minimum diameters of the vessel at the most narrowed proximal location (A) and the distal reference (B). A–B distance represents the interarterial course length of the anomalous vessel. ACAOS anomalous origin of the coronary artery arising from the opposite sinus; CCTA coronary computed tomography angiography; IAC interarterial course.