Anomalous left coronary artery: prepulmonic course
Abnormal coronary angiography - 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).
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
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)
- transseptal (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