Anomalous course of coronary arteries

Dr Daniel J Bell and Radswiki et al.

Anomalous course of a coronary artery is a type of congenital coronary artery anomaly. It may represent a benign and incidental finding, but rarely it is a malignant course predisposing patients to life-threatening myocardial ischemia or arrhythmias, depending on where the artery runs. 

The majority (approximately 80%) of anomalous coronary artery courses are benign and asymptomatic. However, on rare occasions, it may result in ischemia, arrhythmias, or sudden death. Most symptomatic patients present at a young age.

The coronary artery may pass between the aorta and the main pulmonary artery, representing a so-called interarterial course. It may be associated with a "slit-like" orifice in which an acute angle course at the ostium is more prone to occlusion. During physical activity, the artery may be compressed, and the flow within it may be compromised. The presence of a "slit-like" orifice or intramural course of the coronary artery within the aortic wall is more predictive of adverse outcome than the interarterial course alone.

There are four common courses for an anomalous coronary artery arising from the opposite sinus 4,5:

The treatment of anomalous coronary arteries is controversial. Mainly patients with a benign course rarely need surgical treatment. Symptomatic patients with an interarterial course may require surgical "re-implantation" of the anomalous coronary artery or "de-roofing" if an intramural course is present.

Congenital coronary artery anomalies

Article information

rID: 12295
System: Cardiac, Vascular
Section: Anatomy
Synonyms or Alternate Spellings:
  • Coronary artery anomalous course
  • Coronary arterial anomalous courses

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Case 1: interarterial course of RCA
    Drag here to reorder.
  • Case 2: interarterial course of LCA
    Drag here to reorder.
  • Case 3: anomalous course of circumflex artery
    Drag here to reorder.
  • Case 4: anomalous prepulmonic LAD
    Drag here to reorder.
  • Case 5: anomalous septal LAD
    Drag here to reorder.
  • Case 6: intra-cavitary course of RCA
    Drag here to reorder.
  • Case 7: myocardial bridging
    Drag here to reorder.
  • Case 8: interarterial course of LMCA
    Drag here to reorder.
  • Case 9: LMCA off RCA with a benign course
    Drag here to reorder.
  • Case 10: tubular origin of RCA
    Drag here to reorder.
  • Case 11: malignant RCA
    Drag here to reorder.
  • Case 12a: left main from non coronary sinus
    Drag here to reorder.
  • Case 12b: interarterial course of proximal RCA
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.