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Anomalous origin and course of the coronary arteries*

Published online by Cambridge University Press:  01 December 2010

Anthony Hlavacek ,
Marios Loukas ,
Diane Spicer  and
Robert H. Anderson
Anthony Hlavacek
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States of America
Marios Loukas
Affiliation:
Department of Anatomical Sciences, School of Medicine, St George’s University, Grenada, West Indies
Diane Spicer
Affiliation:
Congenital Institute of Florida, All Children’s Hospital, St Petersburg, Florida, United States of America Division of Pediatric Cardiology, University of Florida, Gainesville, Florida, United States of America
Robert H. Anderson*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States of America Cardiac Unit, Institute of Child Health, University College, London, United Kingdom
*
Correspondence to: Professor R. H. Anderson, BSc, MD, FRCPath, 60 Earlsfield Road, London SW18 3DN, United Kingdom. Tel: +00 44 20 8870 4368; E-mail: r.anderson@ich.ucl.ac.uk
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Abstract

In the normal heart, the right and left coronary arteries arise from the aortic valvar sinuses adjacent to the pulmonary trunk. The right coronary artery then directly enters the right atrioventricular groove, whereas the main stem of the left coronary artery runs a short course before dividing to become the anterior interventricular and circumflex arteries. These arteries can have an anomalous origin from either the aorta or pulmonary trunk; their branches can have various anomalous origins relative to arterial pedicles. Other abnormal situations include myocardial bridging, abnormal communications, solitary coronary arteries, and duplicated arteries. Understanding of these variations is key to determining those anomalous patterns associated with sudden cardiac death. In the most common variant of an anomalous origin from the pulmonary trunk, the main stem of the left coronary artery arises from the sinus of the pulmonary trunk adjacent to the anticipated left coronary arterial aortic sinus. The artery can, however, arise from a pulmonary artery, or the right coronary artery can have an anomalous pulmonary origin. The key feature in the anomalous aortic origin is the potential for squeezing of the artery, produced by either the so-called intramural origin from the aorta, or the passage of the abnormal artery between the aortic root and the subpulmonary infundibulum.

Keywords

Coronary arterial anomaliessudden cardiac deathBland–White–Garland syndrome
Type
Original Article
Information
Cardiology in the Young , Volume 20 , Issue S3: Rare and Challenging Congenital Cardiac Lesions: an Interdisciplinary Approach , December 2010 , pp. 20 - 25
Copyright
Copyright © Cambridge University Press 2010

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Footnotes

*

This review is based heavily on the chapters initially written for the book “Coronary Artery Stenosis – Imaging, Structure, and Physiology”, and edited by Javier Escaned and Patrick Serruys.

References

1.Corrado, D, Basso, C, Thiene, G. Sudden cardiac death in young people with apparently normal heart. Cardiovasc Res 2001; 50: 399–408.CrossRefGoogle ScholarPubMed
2.Corrado, D, Basso, C, Pavei, A, Michieli, P, Schiavon, M, Thiene, G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 2006; 296: 1593–1601.CrossRefGoogle ScholarPubMed
3.Montagnana, M, Lippi, G, Franchini, M, Banfi, G, Guidi, GC. Sudden cardiac death in young athletes. Intern Med 2008; 47: 1373–1378.CrossRefGoogle ScholarPubMed
4.Yamanaka, O, Hobbs, RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990; 21: 28–40.CrossRefGoogle ScholarPubMed
5.Ogden, JA. Congenital anomalies of the coronary arteries. Am J Cardiol 1970; 25: 474–479.CrossRefGoogle ScholarPubMed
6.Loukas, M, Groat, C, Khangura, R, Owens, DG, Anderson, RH. The normal and abnormal anatomy of the coronary arteries. Clin Anat 2009; 22: 114–128.CrossRefGoogle ScholarPubMed
7.Muriago, M, Sheppard, MN, Ho, SY, Anderson, RH. Location of the coronary arterial orifices in the normal heart. Clin Anat 1997; 10: 297–302.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
8.Gittenberger-de Groot, AC, Sauer, U, Quaegebeur, J. Aortic intramural coronary artery in three hearts with transposition of the great arteries. J Thor Cardiovasc Surg 1986; 91: 566–571.CrossRefGoogle ScholarPubMed
9.Gittenberger-de Groot, AC, Sauer, U, Oppenheimer-Dekker, A, Quaegebeur, J. Coronary arterial anatomy in transposition of the great arteries: a morphologic study. Ped Cardiol 1983; 4: 15–24.Google Scholar
10.Lacour-Gayet, F, Anderson, RH. A uniform surgical technique for transfer of both simple and complex patterns of the coronary arteries during the arterial switch procedure. Cardiol Young 2005; 15 (Suppl 1): 93–101.CrossRefGoogle ScholarPubMed
11.Samarendra, P, Kumari, S, Hafeez, M, Vasavada, BC, Sacchi, TJ. Anomalous circumflex coronary artery: benign or predisposed to selective atherosclerosis. Angiology 2001; 52: 521–526.CrossRefGoogle ScholarPubMed
12.Angelini, P. Coronary artery anomalies: an entity in search of an identity. Circulation 2007; 115: 1296–1305.CrossRefGoogle ScholarPubMed
13.Robiseck, F, Sanger, PW, Daugherty, HK, Gallucci, V. Origin of the anterior interventricular (descending) coronary artery and vein from the left mammary vessels. A previously unknown anomaly of the coronary system. J Thorac Cardiovasc Surg 1967; 53: 602–604.Google Scholar
14.Greenberg, MA, Fish, BG, Spindola-Franco, H. Congenital anomalies of the coronary arteries. Classification and significance. Radiol Clin North Am 1989; 27: 1127–1146.CrossRefGoogle ScholarPubMed
15.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: 1004–1010.CrossRefGoogle Scholar
16.Spindola-Franco, H, Grose, R, Solomon, N. Dual left anterior descending coronary artery: angiographic description of important variants and surgical implications. Am Heart J 1983; 105: 445–455.CrossRefGoogle ScholarPubMed
17.Koizumi, M, Kawai, K, Honma, S, Kodama, K. Anatomical study of the left single coronary artery with special reference to the various distribution patterns of bilateral coronary arteries. Ann Ant 2002; 182: 549–557.CrossRefGoogle Scholar