Congenital coronary artery anomalies

Congenital coronary artery anomalies (CCAAs) are not common, found only in ~1% (range 0.1-2%) of patients ^1,3.

The most important finding to look for is the "malignant" course of anomalous coronary artery, i.e. does the artery run between big pulsating objects - right ventricular outflow tract / pulmonary artery on one side and aorta on the other. Increased pulsations during or following exercise can sometimes compress the coronary artery enough to diminish blood flow to the myocardium, which can cause re-entry phenomenon in the myocardium and sudden cardiac death due to ventricular fibrillation or sustained ventricular tachycardia.

Interarterial "malignant" course is most commonly identified in the right coronary artery, classically presenting in young adults or teenagers with sudden cardiac death. It is estimated that around a quarter of sudden cardiac deaths in this population is caused by malignant coronary artery course.

Intramural course of a coronary artery (known as myocardial bridging) is another lesion which may be hemodynamically significant and present with exertional angina. Usually, it occurs at mid LAD. It is important to describe the location (LAD segment relative to branch vessels), length, and depth of bridging in your report.

Of course, all anomalous coronary artery anatomy should be described in the radiology report, as this may be used to guide catheter angiography by the interventional cardiologist ⁷.

Related pathology

A vast number of different coronary artery abnormalities have been described and are discussed separately (see related articles).