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Congenital coronary artery anomalies in adults: review of 111 cases from a single-centre experience

Published online by Cambridge University Press:  15 November 2016

Yiğit Çanga ,
Tolga S. Güvenç ,
Mehmet B. Karataş ,
Ali N. Çalık ,
Tolga Onuk ,
Veysel O. Tanık ,
Barış Güngör  and
Osman Bolca
Yiğit Çanga*
Affiliation:
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
Tolga S. Güvenç
Affiliation:
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
Mehmet B. Karataş
Affiliation:
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
Ali N. Çalık
Affiliation:
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
Tolga Onuk
Affiliation:
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
Veysel O. Tanık
Affiliation:
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
Barış Güngör
Affiliation:
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
Osman Bolca
Affiliation:
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
*
Correspondence to: Y. Çanga, MD, Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey. Tel: +90 216 545 8695; Fax: +90 216 459 2766; E-mail: [email protected]
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Abstract

Background

Coronary artery anomalies are a heterogeneous group of congenital disorders presenting with a wide spectrum of symptoms, ranging from vague chest pain to sudden cardiac death. Despite available data, there is no consensus about the classification, nomenclature, and outcomes of coronary anomalies in the normally connected heart. In this study, we aimed to investigate clinical and angiographic characteristics of coronary arterial anomalies, as well as the frequency of atherosclerotic involvement in anomalous coronaries, diagnosed at a tertiary referral centre.

Methods

We retrospectively reviewed coronary angiograms performed between 2011 and 2015 for the presence of a coronary anomaly. A total of 111 patients with a final diagnosis of coronary anomaly were included in the study group. We also recruited 110 age- and sex-matched patients who underwent coronary angiography because of symptomatic coronary artery disease as controls.

Results

Among 36,893 coronary angiograms, 111 (0.30%) major coronary anomalies were found. Compared with controls, the prevalence of significant atherosclerotic coronary disease was lower in patients with coronary anomalies and stable symptoms (p=0.02); however, the prevalence of significant coronary atherosclerosis was similar among patients admitted with unstable angina or myocardial infarction (p>0.05). Compared with controls, patients with an anomalous left anterior descending coronary artery had significantly less atherosclerotic involvement than those in whom the left anterior descending artery was not anomalous (p=0.005).

Conclusions

Although coronary artery anomalies are cited as a cause for myocardial ischaemia, atherosclerotic coronary artery disease is also frequent and may offer an alternative explanation to ischaemic symptoms. No predisposition to accelerated atherosclerosis was found, however, and atherosclerotic involvement was less frequent in some anomalous vessels.

Keywords

Coronary angiographycoronary artery anomalycoronary atherosclerosis
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 6 , August 2017 , pp. 1041 - 1050
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Copyright
© Cambridge University Press 2016 

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Footnotes

†

Current address: Tıbbıye street, Siyami Ersek Hospital, Uskudar, 34668, Istanbul, Turkey.

References

1. Akpinar, I, Sayin, MR, Karabag, T, et al. Differences in sex, angiographic frequency, and parameters in patients with coronary artery anomalies: single-center screening of 25 368 patients by coronary angiography. Coron Artery Dis 2013; 24: 266–271.Google Scholar
2. Yuksel, S, Meric, M, Soylu, K, et al. The primary anomalies of coronary artery origin and course: a coronary angiographic analysis of 16,573 patients. Exp Clin Cardiol 2013; 18: 121–123.Google Scholar
3. Angelini, P. Coronary artery anomalies. an entity in search of an identity. Circulation 2007; 115: 1296–1305.Google Scholar
4. Kragel, AH, Roberts, WC. Anomalous origin of either the right or left main coronary artery from the aorta with subsequent coursing between aorta and pulmonary trunk: analysis of 32 necropsy cases. Am J Cardiol 1988; 62: 771–777.CrossRefGoogle ScholarPubMed
5. Cheitlin, MD, De Castro, CM, McAllister, HA. Sudden death as a complications of anomalous left coronary origin from the anterior sinus of Valsalva, a not-so-minor congenital anomaly. Circulation 1974; 50: 780–787.Google Scholar
6. Erdogan, E, Buyuklu, M, Aktoz, M. Anomalous origin of the right coronary artery from the left anterior descending artery in a patient with single left coronary artery: a rare coronary artery anomaly and review of the literature. Int J Cardiol 2008; 127: 280–283.CrossRefGoogle Scholar
7. Scanlon, PJ, Faxon, DP, Audet, AM, et al. ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol 1999; 33: 1756–1824.CrossRefGoogle Scholar
8. Click, RL, Holmes, DR Jr, Vlietstra, RE, Kosinski, AS, Kronmal, RA. Anomalous coronary arteries: location, degree of atherosclerosis and effect on survival – a report from the Coronary Artery Surgery Study. J Am Coll Cardiol 1989; 13: 531–537.CrossRefGoogle ScholarPubMed
9. Chaitman, BR, Lesptrance, J, Saltiel, J, Bourassa, MG. Clinical, angiographic, and hemodynamic findings in patients with anomalous origin ofthe coronary arteries. Circulation 1976; 53: 122–131.Google Scholar
10. Sivri, N, Aktoz, M, Yalta, K, Ozcelik, F, Altun, A. A retrospective study of angiographically determined anomalous coronary arteries in 12,844 subjects in Thrace region of Turkey. Hippokratia 2012; 16: 2246–2249.Google Scholar
11. Eid, AH, Itani, Z, Al-Tannir, M, Sayegh, S, Samaha, A. Primary congenital anomalies of the coronary arteries and relation to atherosclerosis: an angiographic study in Lebanon. J Cardiothorac Surg 2009; 4: 58.CrossRefGoogle ScholarPubMed
12. Sohrabi, S, Habibzadeh, A, Abbasov, E. The incidence and pattern of coronary artery anomalies in the north-west of Iran: a coronary arteriographic study. Korean Circ J 2012; 42: 753–760.CrossRefGoogle ScholarPubMed
13. Suryanarayana, P, Kollampare, S, Bin Riaz, I, et al. Presence of anomalous coronary seen on angiogram is not associated with increased risk of significant coronary artery disease. Int J Angiol 2014; 23: 243–246.CrossRefGoogle Scholar
14. Turkmen, S, Cagliyan, CE, Poyraz, F, et al. Coronary arterial anomalies in a large group of patients undergoing coronary angiography in southeast Turkey. Folia Morphol 2013; 72: 123–127.Google Scholar
15. Garg, N, Tewari, S, Kapoor, A, Gupta, DK, Sinha, N. Primary congenital anomalies of the coronary arteries: a coronary: arteriographic study. Int J Cardiol 2000; 74: 39–46.Google Scholar
16. Yamanaka, O, Hobbs, RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990; 21: 28–40.Google Scholar
17. Salah, AM Said, de Voogt, Willem G, Suat, Bulut, et al. Coronary artery disease in congenital single coronary artery in adults: a Dutch case series. World J Cardiol 2014; 6: 196–204.Google Scholar
18. Nath, A, Kennett, JD, Politte, LL, et al. Anomalous right coronary artery arising from the midportion of the left anterior descending coronary artery – case reports. Angiology 1987; 38: 142–146.CrossRefGoogle ScholarPubMed
19. Ammann, P, Marschall, S, Kraus, M, et al. Characteristics and prognosis of myocardial infarction in patients with normal coronary arteries. Chest 2000; 117: 333–338.CrossRefGoogle ScholarPubMed
20. Ong, P, Athanasiadis, A, Hill, S, et al. Coronary artery spasm as a frequent cause of acute coronary syndrome: the CASPAR (Coronary Artery Spasm In Patients With Acute Coronary Syndrome) Study. J Am Coll Cardiol 2008; 52: 523–527.CrossRefGoogle ScholarPubMed
21. Kardasz, I, De Caterina, R. Myocardial infarction with normal coronary arteries: a conundrum with multiple aetiologies and variable prognosis: un update. J Intern Med 2007; 261: 330–348.Google Scholar
22. Silverman, KJ, Bulkley, BH, Hutchins, GM. Anomalous left circumflex coronary artery: “normal” variant of uncertain clinical and pathologic significance. Am J Cardiol 1978; 41: 1311–1314.Google Scholar
23. Hutchins, GM., Miner, MM, Boitnott, JK. Vessel caliber and branch-angle of human coronary artery branch-points. Circ Res 1976; 38: 572–576.Google Scholar
24. Liu, LB, Richardson, T, Taylor, CB. Atherosclerotic occlusions in anomalous left circumflex coronary-arteries: a report of 2 unusual cases and a review of pertinent literature. Par Arter 1975; 2: 55–59.Google Scholar
25. 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.Google Scholar
26. Harikrishnan, S, Jacob, SP, Tharakan, J, et al. Congenital coronary anomalies of origin and distribution in adults: a coronary arteriographic study. Indian Heart J 2002; 54: 271–275.Google Scholar
27. Page, HL Jr, Engel, HJ, Campbell, WB, Thomas, CS Jr. Anomalous origin of the left circumflex coronary artery: recognition, angiographic demonstration and clinical significance. Circulation 1974; 50: 768–773.CrossRefGoogle Scholar
28. Halon, DA, Sapoznikov, D, Lewis, BS, Gotsman, MS. Localization of lesions in the coronary circulation. Am J Cardiol 1983; 52: 921–926.Google Scholar
29. Çanga, Y, Güvenç, TS, İlhan, E, et al. Providing insights into atherosclerosis: a case of multivessel coronary artery disease with an anomalous straightforward vessel spared from atherosclerosis. Int J angiol 2010; 19: 91–93.Google Scholar
30. Sampaio, RO, Jonke, VM, Falcão, JL, et al. Prevalence of coronary artery disease and preoperative assessment in patients with valvopathy. Arq Bras Cardiol 2008; 91: 183–186.Google ScholarPubMed
31. DM, Lloyd-Jones, Larson, MG, Leip, EP, et al. Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation 2002; 106: 3068–3072.Google Scholar
32. Gheorghiade, M, Sopko, G, De Luca, L, et al. Navigating the crossroads of coronary artery disease and heart failure. Circulation 2006; 114: 1202–1213.Google Scholar