Abnormal coronary artery

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Anomalous coronary arteries are a rare but recognized cause of myocardial ischemia and sudden death. Identification currently requires x-ray angiography, which may have difficulty defining the three-dimensional course of the anomalous vessel. Magnetic resonance coronary angiography (MRCA) has been shown to image coronary artery anatomy noninvasively

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Abnormal coronary artery

  1. 1. Abnormal Coronary Artery RAMACHANDRA
  2. 2. Something should go wrong anatomically? • Number • Location of ostium • Diameter • Cross-sectional area • Course • Branches
  3. 3. Hemodynamically wrong • Major • Minor
  4. 4. Functional anomaly • Ischemia • Shunt • Nothing
  5. 5. What is normal coronary? • That is found in more than 1% of a general population • That is found within 2 SD of the µ value for Gaussian distribution continuous bell curve
  6. 6. Figure 3. Conceptual diagram that shows most of the possible paths (1 through 5) by which the RCA, left anterior descending artery (LAD), and circumflex artery (Cx) can potentially connect with the opposite coronary cusps. Angelini P Circulation. 2007;115:1296-1305 Copyright © American Heart Association, Inc. All rights reserved.
  7. 7. Normal Coronary Anatomy
  8. 8. Normal Coronary Angiogram • Three primary coronary arteries • Left main trunk common stem for LAD and LCX- 90% of cases and is not essential • LAD & LCX are essential • LAD &LC originate from an aortic area located above the upper or middle third of the left coronary sinus of Valsalva (also called the left posterior sinus) • The RCA originates from the upper or middle third of the right sinus of the Valsalva • Coronary ostium is orthogonal to aortic wall.
  9. 9. Anatomical Classification Origin Course Vessel wall collateral termination
  10. 10. Angelini P, Villason S, Chan AV, Diez JG. Normal and anomalous coronary arteries in humans. In: Angelini P, ed. Coronary Artery Anomalies: A Comprehensive Approach. Philadelphia: Lippincott Williams & Wilkins; 1999: 27–150
  11. 11. Origin • 0.6% to 1.2% of CAG in adult • LAD & RCA from LCS but different origin[Split] • High/ Low/ Commissural • From neighbouring sinuses • From neighbouring arteries like ALCAPA
  12. 12. Abnormal origin……..(TGA)
  13. 13. Abnormal origin……..(TGA)
  14. 14. Abnormal origin……..(TGA)
  15. 15. Abnormal origin……..(TGA)
  16. 16. Course • Intramural • Extramural
  17. 17. Intrinsic to any artery • Stenosis • Ectasia • Dual RCA/LAD • Abnormal septal arteries • Myocardial bridge • Subendocardial • Crossing
  18. 18. Collaterals • Coronary cameral fistulas
  19. 19. Relationship • Transposition of the great arteries • Tetralogy of Fallot: 2-9% of tetralogy of Fallot have coronary arterial anomalies. The most common anomaly is origin of the left anterior descending (LAD) coronary artery from the RCA in approximately 4% • Pulmonary atresia with intact ventricular septum : absence of effective egress of blood from the cavity of the right ventricle may preserve primitive embryonic sinusoidal connections to coronary vasculature, resulting in the filling of the connections from the right heart in systole and filling from the aorta in diastole
  20. 20. Tests • Clinical guess • ECG • Echo • TMT • CAG/CTCAG/MR Angio • Nuclear • PET • IVU • OCT
  21. 21. Alarms • • • • • • • • • • • • Irritability Poor Feeding Slowed Or Poor Growth And Development Dyspnea (Difficulty Breathing) Wheezing Diaphoresis (Sweating) /Syncope Grayish Skin Color In Conjunction With Other Symptoms Periods Of Pallor (Pale Skin) Heart Failure Unexpected Chest Pain Presentation In Unusual age SCD
  22. 22. Mortality/Morbidity • Many coronary anomalies are clinically silent • The incidence of incidental coronary anomalies at autopsy includes a single coronary artery in 0.024% and coronary arterial fistulae in 0.2% • After hypertrophic cardiomyopathy, coronary artery abnormalities are the second most common cause of sudden death in young athletes • Race/Sex-No racial predisposition is known.
  23. 23. Treatment Options of symptomatic • Medical treatment/observation • Coronary angioplasty with stent deployment • Surgical repair
  24. 24. Thanks

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