Congenital coronary artery anomalies

Congenital coronary artery anomalies (CCAA's) are not common, found only in approximately 0.1 -2% of patients ^1,3. They can sometimes be associated with sudden death on young patient's

Pathology

A vast number of different abnormalities have been described, and are discussed separately : 

Some of these are listed below (feel free to modify this list as appropriate)

• absent coronary artery(ies) - usually offset of collateral supply
  • absent circumflex artery
  • absent right coronary artery
  • absent left anterior descending coronal artery
  • absent left main trunk (split origination of LCA)
• hypoplastic coronary artery(ies)
  • hypoplastic circumflex artery
  • hypoplastic right coronary artery
  • hypoplastic left anterior descending coronal artery
• anomalous location of coronary ostium within aortic root or near proper aortic sinus of Valsalva (for each artery) 
  • high - high take off
  • low
  • commissural
• ectopic origin(s)
  • anomalous left coronary artery off the pulmonary artery (ALCAPA)
  • ectopic origin from a coronary sinus
    • origination of a coronary artery from the opposite sinus (ACAOS) - there are four recognised patterns ⁶
      • left main artery arising from the right anterior sinus (ALMCA)
      • right coronary artery originating from the left sinus (ARCA)
      • left circumflex or LAD artery arising from the right coronary sinus
      • LCA or RCA (or a branch of either artery) arising from the non-coronary sinus
  • single coronary artery
  • split arteries origins - multiple ostia / duplication of arteries
    • split right coronary arterial (RCA) origin
      • proximal + distal PD(posterior descending arteries) which both arise from RCA
      • proximal PD that arises from RCA with distal PD arising from LAD
      • parallel PDs × 2 (arising from RCA, and circumflex) or “codominant”
    • split left anterior descending arterial (LAD) origin
      • LAD + first large septal branch
      • LAD, double (parallel LADs)
• anomalous course of coronary arteries : often associated with ectopic origin from a coronary sinus
• anomalies of intrinsic coronary arterial anatomy
  • congenital ostial stenosis or atresia (LCA, LAD, RCA, Cx)
  • coronary ostial dimple
  • coronary ectasia or aneurysm
  • intramural coronary artery (muscular bridge)
  • subendocardial coronary course
  • coronary crossing
  • anomalous origination of posterior descending (PD) artery from the anterior descending branch or a septal penetrating branch
  • myocardial bridging
• anomalies in coronary arterial termination
  • inadequate arteriolar / capillary ramifications
  • presence of fistulation from terminal coronary arteries to various structures (coronary artery fistula)
  • extre cardiac termination