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).
Related Radiopaedia articles
Congenital coronary artery anomalies
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congenital coronary artery anomalies
- absent coronary artery
- coronary hypoplasia
- anomalous location of coronary ostia
- from sinotubular junction
- from ascending aorta
- ectopic origin
- anomalous left coronary artery off the pulmonary artery (ALCAPA)
-
anomalous aortic origin of coronary artery
- origination of a coronary artery from the opposite sinus (ACAOS)
- single coronary artery
- LCA or RCA (or a branch of either artery) arising from the non-coronary sinus
- LCx and LAD arising separately from the left coronary sinus
- split artery origins
- anomalous course of coronary arteries
- anomalies of intrinsic coronary arterial anatomy
- congenital ostial stenosis or atresia (LCA, LAD, RCA, Cx)
- coronary ostial dimple
- coronary ectasia or aneurysm
- intramural coronary artery (myocardial bridging)
- subendocardial coronary course
- coronary crossing
- anomalous origin of posterior descending artery (PDA) from the anterior descending branch or a septal penetrating branch
- dual right coronary artery
- dual left anterior descending artery
-
anomalies in coronary arterial termination
- inadequate arteriolar/capillary ramifications
- presence of fistulation from terminal coronary arteries to various structures (coronary arteriovenous fistula)
- extracardiac termination
Anatomy: Thoracic
- thoracic skeleton
- thoracic cage
- thoracic spine
- articulations
- muscles of the thorax
- diaphragm
- intercostal space
- intercostal muscles
- variant anatomy
- spaces of the thorax
- thoracic viscera
- tracheobronchial tree
-
lungs
-
bronchopulmonary segmental anatomy (Boyden Classification) (mnemonic)
- left lung
- right lung
- variant anatomy
- lung parenchyma
- hilum
- pleura
-
bronchopulmonary segmental anatomy (Boyden Classification) (mnemonic)
-
heart
- cardiac chambers
- heart valves
- pectinate muscles
- cardiac fibrous skeleton
-
coronary arteries
- coronary arterial dominance
- myocardial segments
-
left main coronary artery (LMCA)
- ramus intermedius artery (RI)
-
circumflex artery (LCx)
- obtuse marginal branches (OM1, OM2, etc))
- Kugel's artery
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left anterior descending artery (LAD)
- diagonal branches (D1, D2, etc)
- septal perforators (S1, S2, etc)
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right coronary artery (RCA)
- conus artery
- sinoatrial nodal artery
- acute marginal branches (AM1, AM2, etc)
- inferior interventricular artery (PDA)
- posterior left ventricular artery (PLV)
- congenital anomalies
- innervation of the heart
- fetal circulation
-
pericardium
- pericardial space
- oblique pericardial sinus
- transverse pericardial sinus
-
pericardial recesses
- aortic recesses
- pulmonic recesses
- postcaval recess
- pulmonary venous recesses
- pericardial ligaments
- epicardial fat pad
- esophagus
- thymus
- breast
- blood supply of the thorax
- arteries
- veins
- superior vena cava (SVC)
- inferior vena cava (IVC)
-
coronary veins
- cardiac veins which drain into the coronary sinus
- great cardiac vein
- middle cardiac vein
- small cardiac vein
- posterior vein of the left ventricle
- vein of Marshall (oblique vein of the left atrium)
- anterior cardiac veins
- venae cordis minimae (smallest cardiac veins or thebesian veins)
- cardiac veins which drain into the coronary sinus
- pulmonary veins
- thoracoepigastric vein
- lymphatics
- innervation of the thorax
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