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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: [email protected]
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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.

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