Coronary Anomalies
Coronary anomalies are uncommon with a preva-
lence of 1%.
Early detection and evaluation of coronary artery
anomalies is essential because of their potential
association with myocardial ischemia and sudden
death (3).
With the increased use of cardiac-CT, we will see
these anomalies more frequently.
Coronary anomalies can be di^erentiated into
anomalies of the origin, the course and termina-
tion (Table).
The illustration in the left upper corner is the most
common and clinically signiXcant anomaly.
There is an anomalous origin of the LCA from the
right sinus of Valsalva and the LCA courses be-
tween the aorta and pulmonary artery.
This interarterial course can lead to compression
of the LCA (yellow arrows) resulting in myocardial
ischemia.
The other anomalies in the Xgure on the left are
not hemodynamically signiXcant.
Interarterial LCA
On the left images of a patient with an anomalous
origin of the LCA from the right sinus of Valsalva
and coursing between the aorta and pulmonary
artery.
Sudden death is frequently observed in these pa-
tients.
ALCAPA
On the left images of a patient with an anomalous
origin of the LCA from the pulmonary artery, also
known as ALCAPA.
ALCAPA results in the left ventricular myocardium
being perfused by relatively desaturated blood un-
der low pressure, leading to myocardial ischemia.
ALCAPA is a rare, congenital cardiac anomaly ac-
counting for approximately 0.25-0.5% of all con-
genital heart diseases.
Approximately 85% of patients present with clinical
symptoms of CHF within the Xrst 1-2 months of life.
Myocardial bridging
Myocardial bridging is most commonly observed of
the LAD (Xgure).
The depth of the vessel under the myocardium is
more important that the lenght of the myocardial
bridging.
There is debate, whether some of these myocardial
bridges are hemodynamically signiXcant.
Left to right shunt: septal branch of LAD teminates in right
ventricle
Fistula
On the image on the left we see a large LAD giving
rise to a large septal branch that terminates in the
right ventricle (blue arrow).
1.
Introduction to cardiothoracic imaging
by Carl Ja^e and Patrick J. Lynch
2.
Cardiology Site
by M. Abdulla
This site includes instructional movies, 3-D animation,
panoramic views, online quiz, interactive video-clips,
interactive heart sounds & murmurs and interactive
echocardiograms.
3.
Visualization of Anomalous Coronary Arteries on Dual
Source Computed Tomography
by G.J. de Jonge et al
European Radiology, Volume 18, Number 11 / No-
vember, 2008,
2425-2432
28/10/22, 09
:
03
Стр
. 1
из
1
Do'stlaringiz bilan baham: |