Congenital coronary artery anomalies

Last revised by Joachim Feger on 29 Jul 2023

Citation, DOI, disclosures and article data

Citation:

Radswiki T, Feger J, El-Feky M, et al. Congenital coronary artery anomalies. Reference article, Radiopaedia.org (Accessed on 03 Dec 2023) https://doi.org/10.53347/rID-12296

DOI:

https://doi.org/10.53347/rID-12296

Permalink:

https://radiopaedia.org/articles/12296

rID:

12296

Article created:

8 Nov 2010, The Radswiki ◉

Disclosures:

At the time the article was created The Radswiki had no recorded disclosures.

View The Radswiki's current disclosures

Last revised:

29 Jul 2023, Joachim Feger ◉

Disclosures:

At the time the article was last revised Joachim Feger had no financial relationships to ineligible companies to disclose.

View Joachim Feger's current disclosures

Revisions:

29 times, by 16 contributors - see full revision history and disclosures

Systems:

Vascular, Cardiac

Sections:

Anatomy

Tags:

cardiology, stub

Synonyms:

Congenital coronary artery anomaly
Congenital coronary arterial anomalies
Congenital coronary artery anomalies (CCAA)
CCAA
Congenital coronary artery abnormality
Congenital coronary artery abnormalities
Congenital coronary arterial abnormalities
Coronary artery anomalies (CAAs)
Coronary artery anomalies
Coronary artery anomaly
Congenital anomaly of the coronary arteries
Coronary artery variants
Coronary artery variant

Congenital coronary artery anomalies (CCAAs) are not common, found only in ~1% (range 0.1-2%) of patients ^1,3.

The most important finding to look for is the "malignant" course of the anomalous coronary artery, i.e. does the artery run between big pulsating objects - right ventricular outflow tract / pulmonary artery on one side and aorta on the other? Increased pulsations during or following exercise can sometimes compress the coronary artery enough to diminish blood flow to the myocardium, which can cause a re-entry phenomenon in the myocardium and sudden cardiac death due to ventricular fibrillation or sustained ventricular tachycardia.

Interarterial "malignant" course is most commonly identified in the right coronary artery, classically presenting in young adults or teenagers with sudden cardiac death. It is estimated that around a quarter of sudden cardiac deaths in this population are caused by malignant coronary artery course.

An intramural course of a coronary artery (known as myocardial bridging) is another lesion which may be hemodynamically significant and present with exertional angina. Usually, it occurs at mid-LAD. It is important to describe the location (LAD segment relative to branch vessels), length, and depth of bridging in your report.

Of course, all anomalous coronary artery anatomy should be described in the radiology report, as this may be used to guide catheter angiography by the interventional cardiologist ⁷.

Related pathology

A vast number of different coronary artery abnormalities have been described and are discussed separately (see related articles).

Quiz questions

References

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