Anomalous course of coronary arteries
Updates to Article Attributes
Anomalous course of a coronary artery is a type of congenital coronary artery anomaly. It may represent a benign and incidental finding, but can also be life threatening, depending on where the artery runs.
Clinical presentation
This can result in ischaemia, arrhythmias or sudden death.
Pathology
In the majority of cases, the aberrant artery has what is referred to as a benign course. Some, however, pass between the aorta and the main pulmonary artery (so-called interarterial course). When this is the case, and especially during physical activity, the artery may be compressed and flow within it compromised. For this reason this condition is called malignant.
There is increasing evidence that the presence of a 'slit'-like orifice of the coronary artery is more predictive of adverse outcome than the interarterial course alone.
An anomalous coronary artery arising from the opposite sinus usually takes four common courses 4,5:
- interarterial (i.e. between the aorta and the pulmonary artery) - this is the most dangerous as it carries a high risk of sudden cardiac death the so called malignant course.
- retroaortic - benign course
- prepulmonic - benign course
- septal (subpulmonic) - benign course
Treatment and prognosis
If untreated the prognosis is severe. A malignant interarterialAn inter-arterial course may require surgical repairrequires surgical reimplantation of the anomalous coronary artery.
-<p><strong>Anomalous course of a coronary artery</strong> is a type of <a href="/articles/congenital-coronary-artery-anomalies">congenital coronary artery anomaly</a>. It may represent a benign and incidental finding, but can also be life threatening, depending on where the artery runs. </p><h4>Clinical presentation</h4><p>This can result in ischaemia, arrhythmias or sudden death. </p><h4>Pathology</h4><p>In the majority of cases, the aberrant artery has what is referred to as a benign course. Some, however, pass between the aorta and the main pulmonary artery (so-called interarterial course). When this is the case, and especially during physical activity, the artery may be compressed and flow within it compromised. For this reason this condition is called malignant.</p><p>There is increasing evidence that the presence of a 'slit'-like orifice of the coronary artery is more predictive of adverse outcome than the interarterial course alone.</p><h4>Treatment and prognosis</h4><p>If untreated the prognosis is severe. A malignant interarterial course may require surgical repair.</p>- +<p><strong>Anomalous course of a coronary artery</strong> is a type of <a href="/articles/congenital-coronary-artery-anomalies">congenital coronary artery anomaly</a>. It may represent a benign and incidental finding, but can also be life threatening, depending on where the artery runs. </p><h4>Clinical presentation</h4><p>This can result in ischaemia, arrhythmias or sudden death. </p><h4>Pathology</h4><p>In the majority of cases, the aberrant artery has what is referred to as a benign course. Some, however, pass between the aorta and the main pulmonary artery (so-called interarterial course). When this is the case, and especially during physical activity, the artery may be compressed and flow within it compromised. For this reason this condition is called malignant.</p><p>There is increasing evidence that the presence of a 'slit'-like orifice of the coronary artery is more predictive of adverse outcome than the interarterial course alone.</p><p>An anomalous coronary artery arising from the opposite sinus usually takes four common courses <sup>4,5</sup>:</p><ol>
- +<li>interarterial (i.e. between the aorta and the pulmonary artery) - this is the most dangerous as it carries a high risk of sudden cardiac death the so called malignant course.</li>
- +<li>retroaortic - benign course</li>
- +<li>prepulmonic - benign course</li>
- +<li>septal (subpulmonic) - benign course</li>
- +</ol><h4>Treatment and prognosis</h4><p>If untreated the prognosis is severe. An inter-arterial course requires surgical reimplantation of the anomalous coronary artery.</p>
References changed:
- 4. Pursnani A, Jacobs J, Saremi F et al. Coronary CTA Assessment of Coronary Anomalies. J Cardiovasc Comput Tomogr. 2012;6(1):48-59. <a href="https://doi.org/10.1016/j.jcct.2011.06.009">doi:10.1016/j.jcct.2011.06.009</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22264632">Pubmed</a>
- 5. Kim S, Seo J, Do K et al. Coronary Artery Anomalies: Classification and ECG-Gated Multi–Detector Row CT Findings with Angiographic Correlation. Radiographics. 2006;26(2):317-33. <a href="https://doi.org/10.1148/rg.262055068">doi:10.1148/rg.262055068</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/16549600">Pubmed</a>
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