Anomaly of coronary artery

1. coronary artery anomalies : ) By:Ibrahim Alduraywish

2. Q1 Which of these best describes a 'malignant' course of a coronary artery? A. coronary artery arises from the left coronary cusp B. coronary artery passes between the aorta and pulmonary trunk (interarterial) C. coronary artery passes posterior to the aorta (retroaortic) D. left coronary artery passes anterior to the pulmonary trunk (pre-pulmonic)

3. Why its important ? • The 2nd most common cause of sudden cardiac death after ? (malignant coronary artery course) • Its common ? Congenital coronary artery anomalies (CCAAs) are not common, found only in ~1% (range 0.1-2%) The incidenceof (malignant coronary artery course) is estimated at ~1.3% of coronary anomalies

4. coronary artery anomalies • congenital coronary artery anomalies • absent coronary artery • coronary hypoplasia • ectopic origin • anomalous course of coronary arteries • benign course • malignant course • anomalies of intrinsic coronary arterial anatomy • anomalies in coronary arterial termination

7. Normal anatomyof Coronaryarteries

8. Coronary artery CT (normal) • https://radiopaedia.org/cases/coronary-artery-ct-normal?lang=gb Coronary artery CT (normal)

11. Normal anatomyof Coronaryarteries

16. Anomalous course coronary arteries

17. Anomalous course of coronary arteries • Benign course of coronary arteries J • prepulmoniccourse • retroaorticcourse • transseptalcourse • intra-atrial course of theright coronary artery

18. Anomalous course of coronary arteries • Benign course of coronary arteries J • prepulmoniccourse • retroaorticcourse • transseptalcourse • intra-atrial course of theright coronary artery

19. Anomalous course of coronary arteries • Benign course of coronary arteries J • prepulmoniccourse • retroaorticcourse • transseptalcourse • intra-atrial course of the right coronary artery

20. Anomalous course of coronary arteries • Benign course of coronary arteries J • prepulmoniccourse 1- No hemodynamicconsequences However, it has been associated with angina in somecasereports. 2 -Association tetralogy of Fallot. 3- Patient management will entirely depend on symptoms and on associated findings.

21. Anomalous course of coronary arteries • Benign course of coronary arteries J • Prepulmoniccourse • Retroaortic course • Transseptal course • Intra-atrialcourse of the right coronary artery

22. Anomalous course of coronary arteries • Benign course of coronary arteries J • Prepulmoniccourse • Retroaorticcourse • Transseptal course • Intra-atrialcourse of the right coronary artery

23. Anomalous course of coronary arteries • Benign course of coronary arteries J • Retroaorticcourse 1- Similarto a prepulmonicanomalous coronary artery course, a retroaorticcourseis thought to not beof increased haemodynamicrisk 2 -Association othercongenital coronary artery anomalies 3- Patient management will entirely depend on symptoms and on associated findings.

24. Anomalous course of coronary arteries • Benign course of coronary arteries J • Prepulmoniccourse • Retroaortic course • Transseptal course • Intra-atrialcourse of the right coronary artery

25. Anomalous course of coronary arteries • Benign course of coronary arteries J • Prepulmoniccourse • Retroaortic course • Transseptal course • Intra-atrialcourse of the right coronary artery Runsanteriorlyandinferiorlytothe aortic valve in asubpulmonic routethrough theinterventricularseptal myocardium

26. Anomalous course of coronary arteries • Benign course of coronary arteries J • Transseptal course Runs anteriorly and inferiorly to theaortic valve in a subpulmonic route through the interventricular septal myocardium 1- Similarto a prepulmonicorretroaorticcoursea transseptal courseis apparently not of increased haemodynamicrisk . 2 -Association othercongenital coronary artery anomalies 3- Patient management will entirely depend on symptoms and on associated findings.

27. Anomalous course of coronary arteries • Benign course of coronary arteries J • Prepulmoniccourse • Retroaorticcourse • Transseptalcourse • Intra-atrialcourse of the right coronary artery

28. Anomalous course of coronary arteries • Benign course of coronary arteries J • Prepulmoniccourse • Retroaorticcourse • Transseptalcourse • Intra-atrialcourse of the right coronary artery The RCA vessel partially or completely courses through the right atrial chamber

29. Anomalous course of coronary arteries • Benign course of coronary arteries J • Intra-atrialcourse of the right coronary artery The RCA vessel partially or completely courses through the right atrial chamber Usually asymptomaticand clinically occult but is of radiological significancein any fluoroscopicprocedurerequiring a wireor catheterto bepassed through theright atrium, in which it is proneto injury causing right coronal artery territory ischaemia orinfarction.

30. Anomalous course of coronary arteries malignant course of coronary arteries :( • Inter-arterial course of the left coronary artery • Inter-arterial course of the right coronary artery

33. Anomalous course of coronary arteries malignant course of coronary arteries :( • Inter-arterial course of the left coronaryartery - Occlusion during physical activityduetocompression between themajor arteries. -Managementofan aberrantleftcoronaryarterywith interarterial course is complex,anddependson factorswhich include patientage,associated symptoms,evidence ofmyocardial ischaemia,andsurgeon preference

36. Anomalous course of coronary arteries malignant course of coronary arteries :( • Inter-arterial course of the right coronary artery Increased risk of cardiacischaemia, myocardial infarction, and possibly sudden death.theaberrant courseof theright coronary artery to beless concerning than an aberrant courseof theleft coronary artery.Repairstrategies vary depending on the institution's level of concern.

41. Thanks

Anomaly of coronary artery

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