Open AccessJournal Article
Coronary artery anomalies--current clinical issues: definitions, classification, incidence, clinical relevance, and treatment guidelines.
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This work proposes that the left anterior descending, circumflex, and right coronary arteries be considered the essential elementary units of coronary anatomy and suggests that the coronary arteries should be defined not by their origin or proximal course, but by their intermediate and distal segments or dependent microvascular bed.Abstract:
The study of coronary artery anomalies would benefit from the clarification of various fundamental issues, including the definitions, classification, incidence, pathophysiologic mechanisms, and clinical relevance of each anomaly. The greatest challenge is to identify the abnormality and determine its clinical relevance so that appropriate treatment can be instituted.
Currently, the coronary anatomy is essentially defined by the features of the (conductive) epicardial coronary tree and its dependent territory. Therefore, one must consider all the possible and observed variations in anatomic features that are used to describe the coronary arteries. We propose that the left anterior descending, circumflex, and right coronary arteries be considered the essential, elementary units of coronary anatomy. We also suggest that the coronary arteries be defined not by their origin or proximal course, but by their intermediate and distal segments or dependent microvascular bed.
A strict classification system is necessary before meaningful data can be gathered about the incidence of coronary anomalies. With respect to clinical relevance, the greatest challenge is presented by anomalies that only occasionally cause critically severe clinical events and are otherwise compatible with a normal life. In such cases, it is not known whether the specific features of a given anomaly cause adverse clinical consequences, or whether additional episodic factors are required.
To correlate subclassifiable anatomic and functional features with clinical events and prognoses, a large, multicenter database, relying on prospective, coordinated protocols, is urgently needed. In the absence of established official guidelines, we present practical protocols for diagnosing and treating coronary anomalies. (Tex Heart Inst J 2002;29:271–8)read more
Citations
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Identifying, Characterizing, and Classifying Congenital Anomalies of the Coronary Arteries
Jabi E. Shriki,Jerold S. Shinbane,Mollie A Rashid,Antereas Hindoyan,James G Withey,Anthony DeFrance,Mark J. Cunningham,George R. Oliveira,Bill H. Warren,Alison Wilcox +9 more
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Long-Term Outcome and Impact of Surgery on Adults With Coronary Arteries Originating From the Opposite Coronary Cusp
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TL;DR: In this single-center cohort study of patients with an anomalous coronary artery from the opposite sinus of Valsalva, surgical management appears to have been favored recently and despite no perioperative mortality, a positive impact on long-term survival was not observed.
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Non-atherosclerotic coronary artery disease associated with sudden cardiac death
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References
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Journal ArticleDOI
Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes.
TL;DR: Standard testing with ECG under resting or exercise conditions is unlikely to provide clinical evidence of myocardial ischemia and would not be reliable as screening tests in large athletic populations, and premonitory cardiac symptoms not uncommonly occurred shortly before sudden death, suggesting that a history of exertional syncope or chest pain requires exclusion of this anomaly.
Journal ArticleDOI
Coronary Anomalies Incidence, Pathophysiology, and Clinical Relevance
TL;DR: By determining the incidence of anatomic variants in a large population, acceptable definitions of normal and anomalous anatomy could be established and the clinical importance of anomalous variants ascertained and the rational paradigm generated would generate a rational paradigm.
Journal ArticleDOI
Sudden cardiac death associated with isolated congenital coronary artery anomalies.
TL;DR: In this paper, the authors found that younger patients with an isolated coronary artery anomaly are significantly more likely than older patients (≥ 30 years old) to die suddenly (62% vs. 12%, p = 0.0001) or during exercise.
Journal ArticleDOI
Major coronary artery anomalies in a pediatric population: incidence and clinical importance.
TL;DR: In this article, the incidence and clinical significance of major coronary artery anomalies in asymptomatic children using transthoracic two-dimensional echocardiography was evaluated.
Journal ArticleDOI
ALCAPA syndrome: an example of chronic myocardial hypoperfusion?
TL;DR: These ultrastructural studies suggest delayed subcellular adaptive responses in the chronically hypoperfused myocardium of patients with ALCAPA syndrome.
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