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Coronary Artery Anomalies: When You Need to Worry

  • Congenital Heart Disease (RA Krasuski, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

There is a broad spectrum of coronary artery anomalies that cardiologists may encounter either incidentally or during evaluation for cardiac symptoms. These anomalies include anomalous coronary arteries arising from the opposite sinus of Valsalva (ACAOS), coronary fistulae, and coronary artery aneurysms. This manuscript outlines the unique features, diagnostic characteristics, and treatment considerations for these lesions.

Recent Findings

Intravenous ultrasound (IVUS), computed tomographic angiography (CTA), and magnetic resonance imaging (MRI) are becoming more sophisticated and will be increasingly used to facilitate the optimal treatment approach for coronary anomalies.

Summary

There are a wide variety of coronary artery anomalies and their clinical ramifications range from benign to potentially fatal. Coronary anomalies often have complex anatomy and require advanced imaging modalities for comprehensive characterization. Due to the heterogeneity in lesion characteristics and outcomes, physicians should consider clinical and imaging features to create individualized management plans, along with referral to adult congenital heart disease centers.

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References

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  1. Krasuski RA, et al. Long-term outcome and impact of surgery on adults with coronary arteries originating from the opposite coronary cusp. Circulation. 2011;123(2):154–62.

    Article  PubMed  Google Scholar 

  2. Maron BJ. Sudden death in young athletes. N Engl J Med. 2003;349(11):1064–75.

    Article  CAS  PubMed  Google Scholar 

  3. Eckart RE, et al. Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med. 2004;141(11):829–34.

    Article  PubMed  Google Scholar 

  4. Taylor AJ, Rogan KM, Virmani R. Sudden cardiac death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol. 1992;20(3):640–7.

    Article  CAS  PubMed  Google Scholar 

  5. Angelini P. Coronary artery anomalies: an entity in search of an identity. Circulation. 2007;115(10):1296–305.

    PubMed  Google Scholar 

  6. Warnes CA, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008;118(23):e714–833.

    Article  PubMed  Google Scholar 

  7. • Angelini P. Novel imaging of coronary artery anomalies to assess their prevalence, the causes of clinical symptoms, and the risk of sudden cardiac death. Circ Cardiovasc Imaging. 2014;7(4):747–54. This paper highlights the role of novel imaging tools such as magnetic resonance angiography, computed tomography angiography, and optical coherence tomography in diagnosing and risk stratifying patients with coronary artery anomalies

    Article  PubMed  Google Scholar 

  8. •• Van Hare GF, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 4: congenital heart disease: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2372–84. This paper establishes guideline recommendations regarding optimal care for trained athletes with cardiac disease

    Article  PubMed  Google Scholar 

  9. Fedoruk LM, et al. Anomalous origin of the right coronary artery: right internal thoracic artery to right coronary artery bypass is not the answer. J Thorac Cardiovasc Surg. 2007;133(2):456–60.

    Article  PubMed  Google Scholar 

  10. Poynter JA, et al. Anomalous aortic origin of a coronary artery: a report from the congenital heart surgeons society registry. World J Pediatr Congenit Heart Surg. 2014a;5(1):22–30.

    Article  PubMed  Google Scholar 

  11. Poynter JA, et al. Repair of anomalous aortic origin of a coronary artery in 113 patients: a Congenital Heart Surgeons’ Society report. World J Pediatr Congenit Heart Surg. 2014b;5(4):507–14.

    Article  PubMed  Google Scholar 

  12. Frommelt PC, et al. Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course. J Am Coll Cardiol. 2003;42(1):148–54.

    Article  PubMed  Google Scholar 

  13. Alegria JR, et al. Myocardial bridging. Eur Heart J. 2005;26(12):1159–68.

    Article  PubMed  Google Scholar 

  14. Mohlenkamp S, et al. Update on myocardial bridging. Circulation. 2002;106(20):2616–22.

    Article  PubMed  Google Scholar 

  15. Sorajja P, et al. Myocardial bridging in adult patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 2003;42(5):889–94.

    Article  PubMed  Google Scholar 

  16. Kiefer TL, et al. Coronary arteriovenous fistulae: the complexity of coronary artery-to-coronary sinus connections. Tex Heart Inst J. 2012;39(2):218–22.

    PubMed  PubMed Central  Google Scholar 

  17. Mangukia CV. Coronary artery fistula. Ann Thorac Surg. 2012;93(6):2084–92.

    Article  PubMed  Google Scholar 

  18. Valente AM, et al. Predictors of long-term adverse outcomes in patients with congenital coronary artery fistulae. Circ Cardiovasc Interv. 2010;3(2):134–9.

    Article  PubMed  Google Scholar 

  19. Brotherton H, Philip RK. Anomalous left coronary artery from pulmonary artery (ALCAPA) in infants: a 5-year review in a defined birth cohort. Eur J Pediatr. 2008;167(1):43–6.

    Article  PubMed  Google Scholar 

  20. Williams IA, Gersony WM, Hellenbrand WE. Anomalous right coronary artery arising from the pulmonary artery: a report of 7 cases and a review of the literature. Am Heart J. 2006;152(5):1004.e9–17.

    Article  Google Scholar 

  21. Pahlavan PS, Niroomand F. Coronary artery aneurysm: a review. Clin Cardiol. 2006;29(10):439–43.

    Article  PubMed  Google Scholar 

  22. Aoki J, et al. Coronary artery aneurysms after drug-eluting stent implantation. JACC Cardiovasc Interv. 2008;1(1):14–21.

    Article  PubMed  Google Scholar 

  23. Satran A, et al. Increased prevalence of coronary artery aneurysms among cocaine users. Circulation. 2005;111(19):2424–9.

    Article  PubMed  Google Scholar 

  24. Demopoulos VP, et al. The natural history of aneurysmal coronary artery disease. Heart. 1997;78(2):136–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the committee on rheumatic fever, endocarditis and Kawasaki disease, council on cardiovascular disease in the young, American Heart Association. Circulation. 2004;110(17):2747–71.

    Article  PubMed  Google Scholar 

  26. Swaye PS, et al. Aneurysmal coronary artery disease. Circulation. 1983;67(1):134–8.

    Article  CAS  PubMed  Google Scholar 

  27. Ruzmetov M, et al. Repair of tetralogy of Fallot with anomalous coronary arteries coursing across the obstructed right ventricular outflow tract. Pediatr Cardiol. 2005;26(5):537–42.

    Article  CAS  PubMed  Google Scholar 

  28. Gupta D, et al. Detection of coronary artery anomalies in tetralogy of Fallot using a specific angiographic protocol. Am J Cardiol. 2001;87(2):241–4. A9

    Article  CAS  PubMed  Google Scholar 

  29. Brown JW, et al. Surgical repair of congenital supravalvular aortic stenosis in children. Eur J Cardiothorac Surg. 2002;21(1):50–6.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA

    Ajar Kochar & Todd Kiefer

  2. 2400 Pratt Street, Durham, NC, 27705, USA

    Ajar Kochar

Authors
  1. Ajar Kochar
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  2. Todd Kiefer
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Corresponding author

Correspondence to Ajar Kochar.

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Conflict of Interest

Ajar Kochar and Todd Kiefer declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Congenital Heart Disease

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Kochar, A., Kiefer, T. Coronary Artery Anomalies: When You Need to Worry. Curr Cardiol Rep 19, 39 (2017). https://doi.org/10.1007/s11886-017-0854-x

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  • DOI: https://doi.org/10.1007/s11886-017-0854-x

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