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Multidetector computed tomography imaging of coronary artery anomalies

Published online by Cambridge University Press:  19 October 2012

Aysel Türkvatan ,
Yeşim Güray  and
Dilek Altınsoy
Aysel Türkvatan*
Affiliation:
Department of Radiology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey
Yeşim Güray
Affiliation:
Department of Cardiology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey
Dilek Altınsoy
Affiliation:
Department of Radiology, Türkiye Yüksek İhtisas Hospital, Sıhhiye, Ankara, Turkey
*
Correspondence to: Dr A. Türkvatan, Radiologist, MD, Department of Radiology, Türkiye Yüksek İhtisas Hospital, Kızılay Street, No. 4, 06100 Sıhhiye, Ankara, Turkey. Tel: 90 312 3061671; Fax: 90 312 3124120; E-mail: [email protected]
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Abstract

Purpose

The purpose of the study was to determine the prevalence of coronary artery anomalies and to demonstrate in which cases multidetector computed tomography has an additional clinical value compared with the conventional angiography.

Material and methods

A total of 2375 multidetector computed tomography studies were retrospectively reviewed to determine the dominance of the coronary artery anomalies. The classification of coronary artery anomalies was made according to anatomical criteria – origin, course, intrinsic anatomy, and termination – and clinical relevance – benign versus malignant.

Results

The coronary artery system was right dominant in 83.99%, left dominant in 8.0%, and co-dominant in 9.01% of the cases. The incidence of the origin and/or course anomalies was 1.76%, that of fistulas was 0.42%, and that of myocardial bridges was 10.82%. Multidetector computed tomography was performed after conventional angiography in 23 cases and it provided additional information regarding its origin and proximal course, as well as its relationship with the aortic root and main pulmonary trunk in 100% of the cases; eight malignant cases were found. In addition, in all of (100%) the six cases with coronary artery fistulas, conventional angiography failed to detect their terminations, which were clearly depicted by multidetector computed tomography.

Conclusion

Multidetector computed tomographic angiography is superior to conventional angiography in delineating the ostial origin and proximal course of anomalous coronary arteries. Furthermore, it reveals the exact relationship of anomalous coronary arteries with the aorta and the pulmonary artery. Anomalies of the intrinsic anatomy and the termination of coronary arteries are also better visualised with multidetector computed tomography.

Keywords

Coronary arteryanomaliesmultidetector computed tomographyangiography
Type
Original Articles
Information
Cardiology in the Young , Volume 23 , Issue 5 , October 2013 , pp. 661 - 674
Copyright
Copyright © Cambridge University Press 2012 

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References

1. Alexander, RW, Grıffıth, GC. Anomalies of the coronary arteries and their clinical significance. Circulation 1956; 14: 800–805.Google Scholar
2. Yamanaka, O, Hobbs, RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990; 21: 28–40.Google Scholar
3. Angelini, P, Velasco, JA, Flamm, S. Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation 2002; 105: 2449–2454.Google Scholar
4. Eckart, RE, Scoville, SL, Campbell, CL, et al. Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med 2004; 141: 829–834.Google Scholar
5. Vastel-Amzallag, C, Le Bret, E, Paul, JF, et al. Diagnostic accuracy of dual-source multislice computed tomographic analysis for the preoperative detection of coronary artery anomalies in 100 patients with tetralogy of Fallot. J Thorac Cardiovasc Surg 2011; 142: 120–126.Google Scholar
6. Shi, H, Aschoff, AJ, Brambs, HJ, Hoffmann, MH. Multislice CT imaging of anomalous coronary arteries. Eur Radiol 2004; 14: 2172–2181.CrossRefGoogle ScholarPubMed
7. Schmitt, R, Froehner, S, Brunn, J, et al. Congenital anomalies of the coronary arteries: imaging with contrast-enhanced, multidetector computed tomography. Eur Radiol 2005; 15: 1110–1121.Google Scholar
8. Schmid, M, Achenbach, S, Ludwig, J, et al. Visualization of coronary artery anomalies by contrast-enhanced multi-detector row spiral computed tomography. Int J Cardiol 2006; 111: 430–435.Google Scholar
9. Cademartiri, F, La Grutta, L, Malagò, R, et al. Prevalence of anatomical variants and coronary anomalies in 543 consecutive patients studied with 64-slice CT coronary angiography. Eur Radiol 2008; 18: 781–791.Google Scholar
10. Koşar, P, Ergun, E, Oztürk, C, Koşar, U. Anatomic variations and anomalies of the coronary arteries: 64-slice CT angiographic appearance. Diagn Interv Radiol 2009; 15: 275–283.Google Scholar
11. Andreini, D, Mushtaq, S, Pontone, G, et al. Additional clinical role of 64-slice multidetector computed tomography in the evaluation of coronary artery variants and anomalies. Int J Cardiol 2010; 145: 388–390.Google Scholar
12. Fujimoto, S, Kondo, T, Orihara, T, et al. Prevalence of anomalous origin of coronary artery detected by multi-detector computed tomography at one center. J Cardiol 2011; 57: 69–76.CrossRefGoogle ScholarPubMed
13. 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.CrossRefGoogle ScholarPubMed
14. Greenberg, MA, Fish, BG, Spindola-Franco, H. Congenital anomalies of the coronary arteries. Classification and significance. Radiol Clin North Am 1989; 27: 1127–1146.Google Scholar
15. Fujimoto, S, Kondo, T, Orihara, T, et al. Prevalence of anomalous origin of coronary artery detected by multi-detector computed tomography at one center. J Cardiol 2011; 57: 69–76.Google Scholar
16. de Jonge, GJ, van Ooijen, PM, Piers, LH, et al. Visualization of anomalous coronary arteries on dual-source computed tomography. Eur Radiol 2008; 18: 2425–2432.CrossRefGoogle ScholarPubMed
17. von Ziegler, F, Pilla, M, McMullan, L, et al. Visualization of anomalous origin and course of coronary arteries in 748 consecutive symptomatic patients by 64-slice computed tomography angiography. BMC Cardiovasc Disord 2009; 9: 54.Google Scholar
18. Ropers, D, Gehling, G, Pohle, K, et al. Images in cardiovascular medicine. Anomalous course of the left main or left anterior descending coronary artery originating from the right sinus of Valsalva: identification of four common variations by electron beam tomography. Circulation 2002; 105: e42–e43.Google Scholar
19. Bunce, NH, Lorenz, CH, Keegan, J, et al. Coronary artery anomalies: assessment with free-breathing three-dimensional coronary MR angiography. Radiology 2003; 227: 201–208.Google Scholar
20. 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.Google Scholar
21. 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.Google Scholar
22. Dodge-Khatami, A, Mavroudis, C, Backer, CL. Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy. Ann Thorac Surg 2002; 74: 946–955.Google Scholar
23. Williams, IA, Gersony, WM, Hellenbrand, WE. Anomalous right coronary artery arising from the pulmonary artery: a report of 7 cases and a review of the literature. Am Heart J 2006; 152: e9–e17.Google Scholar
24. El-Menyar, AA, Das, KM, Al-Suwaidi, J. Anomalous origin of the three coronary arteries from the right aortic sinus Valsalva: role of MDCT coronary angiography. Int J Cardiovasc Imaging 2006; 22: 723–729.Google Scholar
25. Desmet, W, Vanhaecke, J, Vrolix, M, et al. Isolated single coronary artery: a review of 50,000 consecutive coronary angiographies. Eur Heart J 1992; 13: 1637–1640.Google Scholar
26. Kim, SY, Seo, JB, Do, KH, et al. Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation. Radiographics 2006; 26: 317–333.Google Scholar
27. Montaudon, M, Latrabe, V, Iriart, X, Caix, P, Laurent, F. Congenital coronary arteries anomalies: review of the literature and multidetector computed tomography (MDCT)-appearance. Surg Radiol Anat 2007; 29: 343–355.Google Scholar
28. Agarwal, PP, Kazerooni, EA. Dual left anterior descending coronary artery: CT findings. Am J Roentgenol 2008; 191: 1698–1701.Google Scholar
29. Kim, PJ, Hur, G, Kim, SY, et al. Frequency of myocardial bridges and dynamic compression of epicardial coronary arteries: a comparison between computed tomography and invasive coronary angiography. Circulation 2009; 119: 1408–1416.CrossRefGoogle ScholarPubMed
30. Leschka, S, Koepfli, P, Husmann, L, et al. Myocardial bridging: depiction rate and morphology at CT coronary angiography-comparison with conventional coronary angiography. Radiology 2008; 246: 754–762.Google Scholar
31. Loukas, M, Curry, B, Bowers, M, et al. The relationship of myocardial bridges to coronary artery dominance in the adult human heart. J Anat 2006; 209: 43–50.Google Scholar
32. Lazoura, O, Kanavou, T, Vassiou, K, Gkiokas, S, Fezoulidis, IV. Myocardial bridging evaluated with 128-multi detector computed tomography coronary angiography. Surg Radiol Anat 2010; 32: 45–50.CrossRefGoogle ScholarPubMed
33. Hostiuc, S, Curca, GC, Dermengiu, D, Dermengiu, S, Hostiuc, M, Rusu, MC. Morphological changes associated with hemodynamically significant myocardial bridges in sudden cardiac death. Thorac Cardiovasc Surg 2011; 59: 393–398.Google Scholar
34. Song, BG, Park, YH, Kang, GH, Chun, WJ. Coronary arteriovenous fistula. Heart Lung Circ 2011; 20: 775.CrossRefGoogle ScholarPubMed
35. Zenooz, NA, Habibi, R, Mammen, L, Finn, JP, Gilkeson, RC. Coronary artery fistulas: CT findings. Radiographics 2009; 29: 781–789.Google Scholar