Anomalous left anterior descending artery: prepulmonic course
Abnormal catheter angio - for characterization
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Both the right coronary artery (black arrow) and left main stem (white arrow) arise from the right coronary sinus (from separate ostia). The left main stem has a pre-pulmonic course, passing anterior to the right ventricular outflow tract.
The left main stem bifurcates into the left anterior descending artery (blue arrow) and circumflex artery (green arrow)
An anomalous coronary artery arising from the opposite sinus usually takes four common courses:
- 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 (malignant course)
- septal (subpulmonic)
In the case above, the course of the LAD is prepulmonic, and this is not a malignant course.
- Pursnani A, Jacobs JE, Saremi F et-al. Coronary CTA assessment of coronary anomalies. J Cardiovasc Comput Tomogr. 6 (1): 48-59. doi:10.1016/j.jcct.2011.06.009 - Pubmed citation
- Kim SY, Seo JB, Do KH et-al. Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation. Radiographics. 26 (2): 317-33. doi:10.1148/rg.262055068 - Pubmed citation