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Gilan İY, Esen K, Balcı Y, Öztürk AH. Prevalence of anomalies and variants of coronary arteries: A single center study by coronary CT angiography. Clin Imaging 2025; 119:110389. [PMID: 39742799 DOI: 10.1016/j.clinimag.2024.110389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 11/25/2024] [Accepted: 12/13/2024] [Indexed: 01/04/2025]
Abstract
PURPOSE It has been demonstrated that the coronary artery anomalies (CAAs) are generally asymptomatic. However, some cases can cause severe life threatening events. As coronary computed tomography angiography (CCTA) has emerged as a non-invasive alternative to invasive coronary angiography for the evaluation of coronary anatomy, the prevalence of CAAs in CCTA may more closely reflect the true prevalence in the general population. So we aimed to review and determine the prevalence of CAAs and variants retrospectively in patients who underwent CCTA at our center. METHODS Reports of 1802 patients who underwent CCTA at the radiology department of our university hospital were traced for CAAs. At least two independent investigators reviewed the images, which were selected for further assessment prior to final classification. RESULTS One hundred and fifty two anomalies in 152 patients (8.44 %) were encountered. Origin of any coronary artery from the pulmonary trunk in 1 (0.06 %), origin of LMCA from right sinus in 1 (0.06 %), origin of right coronary artery (RCA) from left sinus in 5 (0.28 %), origin of left anterior descending artery (LAD) from right sinus in 2 (0.11 %), origin of circumflex branch (RCx) of LMCA from right sinus in 6 (0.33 %), origin of RCx from RCA in 4 (0.22 %), origin of any coronary artery from the ascending aorta in 2 (0.11 %), split RCA in 5 (0.28 %), RCx and left marginal artery from the first diagonal artery in 1 (0.06 %), myocardial bridging in 123 (6.83 %) and fistula in 2 (0.11 %) were detected as CAAs. CONCLUSION The prevalence of CAAs observed in this study was similar to the literature. CCTA can clearly visualize the anomalous origin, course and termination of the coronary artery.
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Affiliation(s)
| | - Kaan Esen
- Mersin University, Faculty of Medicine, Department of Radiology, Mersin, Turkey
| | - Yüksel Balcı
- Mersin University, Faculty of Medicine, Department of Radiology, Mersin, Turkey.
| | - Ahmet Hakan Öztürk
- Mersin University, Faculty of Medicine, Department of Anatomy, Mersin, Turkey
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Baz RO, Refi D, Scheau C, Savulescu-Fiedler I, Baz RA, Niscoveanu C. Coronary Artery Anomalies: A Computed Tomography Angiography Pictorial Review. J Clin Med 2024; 13:3920. [PMID: 38999486 PMCID: PMC11242126 DOI: 10.3390/jcm13133920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Coronary arteries have a wide range of anatomical variability, and their spectrum ranges from asymptomatic cases to those predisposed to hemodynamic compromise or even sudden cardiac death. This paper aims to review the classification of coronary artery anomalies (CAAs) and illustrate their imaging characteristics by highlighting the important role of CT coronary angiography. Some of the coronary anomalies usually met in current practice are the high origin coronary artery, multiple ostia, aberrant origin from the opposite/non-coronary Valsalva sinus, single coronary artery, ALCAPA syndrome, duplications of the left anterior descending artery, coronary fistulas, and extracardiac terminations. CT coronary angiography is a non-invasive diagnostic modality for CAAs. The complex anatomy of these anomalies can be accurately described by employing 3D reconstructions and post-processing techniques. Knowledge of the imaging characteristics and potential functional impact of these anomalies is essential for accurate diagnosis and therapeutic planning of patients.
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Affiliation(s)
- Radu Octavian Baz
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
- Department of Radiology and Medical Imaging, Faculty of Medicine, "Ovidius" University, 900527 Constanta, Romania
| | - Deria Refi
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
| | - Cristian Scheau
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania
| | - Ilinca Savulescu-Fiedler
- Department of Internal Medicine, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Internal Medicine and Cardiology, Coltea Clinical Hospital, 030167 Bucharest, Romania
| | - Radu Andrei Baz
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
| | - Cosmin Niscoveanu
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
- Department of Radiology and Medical Imaging, Faculty of Medicine, "Ovidius" University, 900527 Constanta, Romania
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Gherasie FA, Popescu MR, Bartos D. Acute Coronary Syndrome: Disparities of Pathophysiology and Mortality with and without Peripheral Artery Disease. J Pers Med 2023; 13:944. [PMID: 37373933 DOI: 10.3390/jpm13060944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023] Open
Abstract
There are a number of devastating complications associated with peripheral artery disease, including limb amputations and acute limb ischemia. Despite the overlap, atherosclerotic diseases have distinct causes that need to be differentiated and managed appropriately. In coronary atherosclerosis, thrombosis is often precipitated by rupture or erosion of fibrous caps around atheromatous plaques, which leads to acute coronary syndrome. Regardless of the extent of atherosclerosis, peripheral artery disease manifests itself as thrombosis. Two-thirds of patients with acute limb ischemia have thrombi associated with insignificant atherosclerosis. A local thrombogenic or remotely embolic basis of critical limb ischemia may be explained by obliterative thrombi in peripheral arteries of patients without coronary artery-like lesions. Studies showed that thrombosis of the above-knee arteries was more commonly due to calcified nodules, which are the least common cause of luminal thrombosis associated with acute coronary events in patients with acute coronary syndrome. Cardiovascular mortality was higher in peripheral artery disease without myocardial infarction/stroke than in myocardial infarction/stroke without peripheral artery disease. The aim of this paper is to gather published data regarding the disparities of acute coronary syndrome with and without peripheral artery disease in terms of pathophysiology and mortality.
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Affiliation(s)
| | - Mihaela-Roxana Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila," 050474 Bucharest, Romania
- Department of Cardiology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 011461 Bucharest, Romania
| | - Daniela Bartos
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila," 050474 Bucharest, Romania
- Department of Internal Medicine, Clinical University Emergency Hospital, 014461 Bucharest, Romania
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Almalki ME, Alshumrani FA, Almalki HA, Saati AA, Alzahrani SE, Khouj SM. Regional Myopericarditis Mimicking Inferior Myocardial Infarction Following COVID-19 Vaccination: A Rare Adverse Event. Cureus 2023; 15:e41168. [PMID: 37529509 PMCID: PMC10389750 DOI: 10.7759/cureus.41168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/03/2023] Open
Abstract
We present the case of a 41-year-old man who developed myopericarditis after receiving the Pfizer COVID-19 vaccine. The patient experienced a sudden onset of chest and abdominal pain 16 days after vaccination. Electrocardiogram findings revealed deep T-wave inversion and minimal ST-segment elevation. Further investigation through coronary artery angiography and computed tomography identified an anomalous left main coronary artery. Magnetic resonance imaging confirmed the diagnosis of myopericarditis. This case highlights the importance of considering myopericarditis as a potential cause of chest pain and elevated cardiac biomarkers following COVID-19 vaccination, particularly in young individuals. Clinicians should be aware of this adverse event and include it in the differential diagnosis for patients presenting with similar symptoms after vaccination.
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Affiliation(s)
- Mohammed E Almalki
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Fahad A Alshumrani
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Hussam A Almalki
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Asim A Saati
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Saeed E Alzahrani
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Saleh M Khouj
- Department of Interventional Cardiology and Structural Heart Disease, King Abdullah Medical City, Makkah, SAU
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Capisizu AS, Cuzino D, Stanciu SM. A Pilot Study on the Role of Computed Tomography in the Management of Patients with Coronary Artery Anomalies in Romania. J Cardiovasc Dev Dis 2023; 10:jcdd10040170. [PMID: 37103049 PMCID: PMC10142656 DOI: 10.3390/jcdd10040170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/09/2023] [Accepted: 04/13/2023] [Indexed: 04/28/2023] Open
Abstract
Coronary artery anomalies may occur during embryogenesis and can lead to changes in the vascularization of the heart, possible ischemia, and an increased risk of sudden death. A retrospective study was conducted with the aim of assessing the prevalence of coronary anomalies in a Romanian sample of patients, investigated with computed tomography angiography for coronary artery disease. The objectives of the study were to identify the anomalies of the coronary arteries and to conduct an anatomical classification according to Angelini. The study also consisted of evaluations regarding coronary artery calcification in the sample of patients by the Agatston calcium score and assessments regarding the presence of cardiac symptoms and their association with coronary abnormalities. The results showed a prevalence of coronary anomalies of 8.7%, of which 3.8% were origin and course anomalies and 4.9% were coronary anomalies with intramuscular bridging of the left anterior descending artery. Recommendations for practice include the widespread use of coronary computed tomography angiography for the diagnosis of coronary artery anomalies and coronary artery disease in larger patient groups and encouraging this investigation across the country.
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Affiliation(s)
- Adriana Sorina Capisizu
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania
| | - Dragos Cuzino
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania
- Clinical Radiology-Medical Imaging Center, Dr. Carol Davila Central Military Emergency University Hospital, 134 Calea Plevnei Str., 010825 Bucharest, Romania
| | - Silviu Marcel Stanciu
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania
- Center for Cardiovascular Diseases, Laboratory of Noninvasive Cardiovascular Functional Explorations, Dr. Carol Davila Central Military Emergency University Hospital, 134 Calea Plevnei Str., 010825 Bucharest, Romania
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Shabestari AA, Mahdavi A, Abrishami A, Alahyari S, Molla M. Coronary artery calcification: Effects on severity and survival in patients with COVID-19. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2022; 27:89. [PMID: 36685025 PMCID: PMC9854912 DOI: 10.4103/jrms.jrms_584_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 05/05/2022] [Accepted: 07/04/2022] [Indexed: 12/24/2022]
Abstract
Background The aim of this study was to evaluate the effect of coronary artery calcification on disease severity and prognosis in patients with coronavirus disease-2019 (COVID-19). Materials and Methods One hundred and forty-one patients with COVID-19 were included in this study. The severity of pulmonary involvement and calcification of coronary arteries were assessed by computed tomography scan and calcification was classified by two methods: Weston and segmental. In both the methods, patients were divided into three groups with scores of 0, 1-6, and 7-12, which are called groups 1, 2, and 3, respectively. Results The mean age of patients was 54.26 ± 14.55. Difference in score of pulmonary involvement was reported to be significant between deceased and discharged patients (11.73 ± 5.26 and 7.28 ± 4.47, P = 0.002, respectively). In Weston score system, the chance of recovery of Group 1 patients was significantly higher than Group 3 (odds ratio [OR] =6.72, P = 0.05, 95% confidence interval [CI] =1.901-50.257). Similar results were observed in the segmental scoring system (OR =6.34, P = 0.049, 95% CI =1.814-49.416). Despite the higher chance of severe disease in patients with coronary artery calcification, this increase was not statistically significant in either Weston or segmental methods (OR =0.47, P = 0.23 and OR =0.85, P = 0.79, respectively). Conclusion Coronary artery calcification in patients with COVID-19 has a significant association with poor prognosis. However, no significant relationship was observed between this issue and the severity.
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Affiliation(s)
| | - Arash Mahdavi
- Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Abrishami
- Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sam Alahyari
- Department of Internal Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdieh Molla
- Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Li C, Zhang W, Zhang L, Xie Y, Li X. STEMI in an adolescent boy due to anomalous left main coronary artery arising from the right sinus of Valsalva: Case report and brief review of the literature. Radiol Case Rep 2022; 18:4-7. [PMID: 36324853 PMCID: PMC9619146 DOI: 10.1016/j.radcr.2022.09.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/23/2022] [Accepted: 09/28/2022] [Indexed: 11/23/2022] Open
Abstract
Congenital anomalous origin of coronary artery is a rare cardiovascular malformation and the most common anomaly is the left circumflex (LCX) arising from the right sinus of Valsalva (RSV). Other forms include both coronary arteries from RSV, the left anterior descending coronary artery from RSV, and a single coronary artery from the left sinus of Valsalva. Despite being rare, anomalous origin of left main coronary artery (LMCA) from RSV carries a high risk of sudden cardiac death. Here, we report a case of 13-year-old boy with chest pain and acute extensive anterior ST-segment elevation myocardial infarction (STEMI) who was initially diagnosed as acute myocarditis in the emergency department. A bedside echocardiogram showed severe global hypokinesia of left ventricle (LV) and normal right ventricle (RV) function. Coronary computed tomography angiography (CCTA) examination showed LMCA originated from the RSV. The patient underwent coronary artery bypass grafting surgery and was discharged without complications. A timely correct diagnosis of an anomalous coronary artery is critical in symptomatic patients, CCTA plays an important role in clinical decision making.
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Affiliation(s)
- Changcheng Li
- Department of Radiology, Affiliated Taian City Central Hospital of Qingdao University, Taian 271099, Shandong, China
| | - Wenyan Zhang
- Medical Center, the 960th Hospital of the PLA Joint Logistics Support Force, Taian 271000, Shandong, China
| | - Litao Zhang
- Department of Radiology, Affiliated Taian City Central Hospital of Qingdao University, Taian 271099, Shandong, China
| | - Yuanzhong Xie
- Department of Radiology, Affiliated Taian City Central Hospital of Qingdao University, Taian 271099, Shandong, China
| | - Xiujuan Li
- Department of Radiology, Affiliated Taian City Central Hospital of Qingdao University, Taian 271099, Shandong, China,Corresponding author.
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Roberto Schetz Alves M, Momoli J, Lindsey Pilato E, Lenci Marques G. Origin, Course, and Angulation of Coronary Artery Anomaly - A Case Report. Cureus 2022; 14:e28669. [PMID: 36199653 PMCID: PMC9526454 DOI: 10.7759/cureus.28669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
Congenital coronary artery anomalies are a rare diagnosis that can be silent when the patient is asymptomatic. Although these abnormalities may, in most cases, not present clinical alterations, in some cases, they prove to be a cause of myocardial ischemia and sudden death. We report the case of a 20-year-old asymptomatic patient, seen in a routine cardiology consultation, evidenced in an ergometric test ST-segment depression. In this case, follow-up was carried out with coronary angiotomography and scintigraphy to understand the reason for this finding. After the angiotomography has evidenced the diagnosis of anomalous origin and course of the right coronary artery and the trunk of the left coronary artery, in addition to anomalous angulation of the right coronary vessel.
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Bashyal K, Koirala B, Bhattarai A, Baral RK, Khakural P, Shakya S, Kadel PB. Spectrum of coronary anomalies and their categorical approach: rare case series. J Surg Case Rep 2022; 2022:rjac310. [PMID: 35794994 PMCID: PMC9252329 DOI: 10.1093/jscr/rjac310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
The incidence of coronary artery anomalies (CAAs) is 0.2–1.2% of the population. Its paradox of being a rare entity with presentation ranging from sudden cardiac death, congestive heart failure, myocardial infarction to being clinically silent, asserts a challenge to its treating physician. Among the various major categories of CAA, we describe four different types of these anomalies in our retrospective evaluation over 2 years. They include – coronary cameral fistula with coronary aneurysm, congenital atresia of left main, anomalous aortic origin of left anterior descending (LAD) and circumflex artery (LCx) with malignant LAD course, anomalous origin of left coronary artery from pulmonary artery (ALCAPA). Although the child with ALCAPA succumbed despite every possible and available timely efforts, other patients had good postoperative recovery and a brief hospital stay.
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Affiliation(s)
- Krishnaprasad Bashyal
- Department of Cardiac Surgery , Manmohan Cardiothoracic Vascular and Transplant Center, TUTH, Kathmandu, Nepal
| | - Bhagawan Koirala
- Department of Cardiac Surgery , Manmohan Cardiothoracic Vascular and Transplant Center, TUTH, Kathmandu, Nepal
| | - Anil Bhattarai
- Department of Cardiac Surgery , Manmohan Cardiothoracic Vascular and Transplant Center, TUTH, Kathmandu, Nepal
| | - Ravi Kumar Baral
- Department of Cardiac Surgery , Manmohan Cardiothoracic Vascular and Transplant Center, TUTH, Kathmandu, Nepal
| | - Prabhat Khakural
- Department of Cardiac Surgery , Manmohan Cardiothoracic Vascular and Transplant Center, TUTH, Kathmandu, Nepal
| | - Samir Shakya
- Department of Pediatric Cardiology , Manmohan Cardiothoracic Vascular and Transplant Center, TUTH, Kathmandu, Nepal
| | - Prashiddha Bikram Kadel
- Department of Cardiac Surgery , Manmohan Cardiothoracic Vascular and Transplant Center, TUTH, Kathmandu, Nepal
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An Extremely Rare Presentation of Four Coronary Anomaly Patterns Originating from the Right Coronary Sinus. Case Rep Cardiol 2022; 2022:7125401. [PMID: 35799974 PMCID: PMC9256456 DOI: 10.1155/2022/7125401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background. “Coronary anomaly” is defined as the coronary feature or pattern seen in <1% of the population. The most common CAAs are anomalies of origin, specifically having a separate LCX and LAD origin with an incidence of 0.41%. The second most common anomaly is the LCX arising from the RCA (0.37%). Treatment options include CABG, coronary unroofing, reimplantation, or medical therapy. Case Presentation. We present the case of an 85-year-old male who presents with an acute coronary syndrome who was found to have an extremely rare combination of different coronary anomaly patterns including left main coronary artery (LMCA) atresia, small LAD arising posteriorly from the right coronary cusp, anomalous left circumflex artery arising from the RCA, and an anomalous LAD arising from the left circumflex artery which is originating from the RCA. Conclusions. To the best of our knowledge, this is the first case report to describe four coronary anomalies in a single patient. When CAAs are diagnosed, it is of utmost importance for cardiologists to do further imaging and workup that might include a stress test to be able to offer patients the best management options.
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Zhingre Sanchez JD, Iaizzo PA. Computationally Assessed 3D Anatomical Proximities and Spatial Relationships Among the Tricuspid Valve Annulus, Right Coronary Artery, and Triangle of Koch: Implications for Transcatheter Tricuspid Annuloplasty Repair. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100033. [PMID: 37273741 PMCID: PMC10236799 DOI: 10.1016/j.shj.2022.100033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/01/2022] [Accepted: 03/28/2022] [Indexed: 06/06/2023]
Abstract
Background Transcatheter-based annuloplasty therapies for tricuspid regurgitation have demonstrated significant development over recent years. However, the tricuspid valve and neighboring vasculature and conductive tissue regions can present anatomical and device deployment challenges. This present study investigated the anatomical dimensions and spatial relationships of the cardiac structures essential to percutaneous annuloplasty procedures: the tricuspid annulus (TA), right coronary artery (RCA), and triangle of Koch border region. Methods Measurements were derived from computational three-dimensional reconstructions of static magnetic resonance imaging scans of perfusion-fixed human hearts (n = 82) with preserved right-sided heart anatomies. This specimen set included heart samples presenting with prediagnosed atrioventricular valvular regurgitation. Results Our anatomical assessments demonstrated that the TA to RCA proximities were intensified with the presence of atrioventricular valvular regurgitation, compared with healthy heart specimens. The minimal distances were frequently located between the lateral and posterior annular points. This annular region corresponds to the RCA distal segments and posterior descending branch origins. Greater portions and incidences of the RCA coursing parallel or inferior to the TA plane were recorded for these diseased hearts. Patient demographic variables (gender, age, and body mass index) were insignificant determinants of change for a majority of our results. Conclusions These three-dimensional reconstructions provide insights to guide the development and future iterations of transcatheter tricuspid valve annuloplasty systems with regards to device anchoring, annular geometry, tissue proximities, and implantation considerations.
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Affiliation(s)
- Jorge D Zhingre Sanchez
- Departments of Surgery and Biomedical Engineering, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paul A Iaizzo
- Departments of Surgery and Biomedical Engineering, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Batra K, Saboo SS, Kandathil A, Canan A, Hedgire SS, Chamarthy MR, Kalva SP, Abbara S. Extrinsic compression of coronary and pulmonary vasculature. Cardiovasc Diagn Ther 2021; 11:1125-1139. [PMID: 34815964 DOI: 10.21037/cdt-20-155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/29/2020] [Indexed: 11/06/2022]
Abstract
Coronary artery disease from atherosclerosis induced stenosis remains the leading cause of acute coronary syndrome (ACS) and death worldwide, however extrinsic compression of coronary arteries from adjacent anatomical and pathological structures is an infrequent but important diagnosis to be aware of, especially given the nonspecific symptoms of chest pain that mimic angina in patients with pulmonary hypertension (PHT) and congenital heart disease. Non-invasive CT angiography is an invaluable diagnostic tool for detection of coronary artery compression, pulmonary artery dilatation and pulmonary vascular compression. Although established guidelines are not available for management of left main coronary artery (LMCA) compression syndrome, percutaneous coronary intervention and stent implantation remain a feasible option for the treatment, specifically for patients with a high surgical risk. Treatment of pulmonary vein or artery compression is more varied and determined by etiology. This review article is focused on detailed discussion of extrinsic compression of coronary arteries, mainly the LMCA and brief discussion on pulmonary vasculature compression by surrounding anatomical and pathological entities, with focus on pathophysiology, clinical features, complications and role of imaging in its diagnosis and management.
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Affiliation(s)
- Kiran Batra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sachin S Saboo
- Division of Cardiothoracic Imaging, Department of Radiology, University of Texas Health Science Center, TX, USA
| | - Asha Kandathil
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Arzu Canan
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sandeep S Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Murthy R Chamarthy
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sanjeeva P Kalva
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical, School, Boston, MA, USA
| | - Suhny Abbara
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Aziz MU, Singh SP. Coronary artery anomalies evaluation with cardiac computed tomography: A review. J Med Imaging Radiat Sci 2021; 52:S40-S50. [PMID: 34479833 DOI: 10.1016/j.jmir.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Coronary artery anomalies involve either their origin, course, or termination of the vessel. Coronary artery anomalies are congenital and relatively few develop symptoms, which can include potentially serious effects like arrhythmia, chest pain, syncope, myocardial infarction, or sudden death. Conventional coronary angiography has been used extensively in the past few decades for evaluation of coronary anomalies. With recent advancements in the software and hardware, noninvasive nature, and excellent temporal and spatial resolution; coronary computed tomographic angiography (CTA) is now the mainstay in the diagnosis of coronary arterial anomalies. Many studies have shown better performance of cardiac CTA compared to invasive angiography in detection of anomalous coronary arteries.
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Affiliation(s)
- Muhammad Usman Aziz
- The University of Alabama at Birmingham, Department of Diagnostic Radiology, Birmingham, AL, USA.
| | - Satinder P Singh
- The University of Alabama at Birmingham, Department of Diagnostic Radiology, Birmingham, AL, USA
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Coronary artery disease imaging reporting and data system (CAD-RADS): what radiologists need to know? Emerg Radiol 2021; 28:1185-1203. [PMID: 34387783 DOI: 10.1007/s10140-021-01973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/16/2021] [Indexed: 11/09/2022]
Abstract
The aim of this work is to review Coronary Artery Disease Imaging Reporting and Data System (CAD-RADS) that was designed to standardize reporting language and improve the communication of data among radiologists and clinicians. Stenotic lesions are graded into 5 grades ranging from 0 (no stenosis) to 5 (total occlusion), where the highest grade represents the final score. The expert consensus platform has added 4 special modifiers (non-diagnostic, stent, graft, and vulnerability) to aid patient management through linking these scores with decision algorithm and treatment plan. Adherence to standard imaging protocol; knowledge of normal, variant, and anomalous anatomy; and skillful evaluation of stenosis are important for proper utilization of this reporting system. Lastly, radiologists should be aware of the inherited benefits, limitations, and common pitfalls of this classification system.
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Rajani P, ElMorsy ElMaghawry M, Mittal T, Mattar W. Anomalous Left Coronary Artery Arising From Right Coronary Sinus in the Setting of Anterior STEMI. JACC Case Rep 2021; 3:1182-1186. [PMID: 34401755 PMCID: PMC8353565 DOI: 10.1016/j.jaccas.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 06/13/2023]
Abstract
We present the case of a 55-year-old man who had a diagnosis of an acute anterior ST-segment elevation myocardial infarction. Emergency angiography demonstrated that both coronary systems originated from the right coronary sinus with a culprit proximal left anterior descending artery lesion, which was stented. This is a rare presentation, with only 1 similar case found in published reports. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Prina Rajani
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Uxbridge, United Kingdom
| | | | - Tarun Mittal
- Department of Imaging, Royal Brompton and Harefield NHS Foundation Trust, Uxbridge, United Kingdom
| | - Wala Mattar
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Uxbridge, United Kingdom
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Alokley AA, Albakr A, Almansori M. Absent Left Anterior Descending Coronary Artery as a Potential Cause of Ischemic Stroke: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931109. [PMID: 34252070 PMCID: PMC8286803 DOI: 10.12659/ajcr.931109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Embolic stroke of undetermined source (ESUS) represents 20-30% of ischemic strokes, with a high risk of recurrence. It usually requires an extensive diagnostic evaluation to address the potential etiologies. Coronary artery anomaly (CAA) of the left anterior descending artery (LAD) is uncommon, and it is known to be linked to myocardial complications. The association of this anomaly with ischemic strokes has not been reported yet. Here, we report on a rare case of a young patient with hypoplastic LAD complicated by an impaired ventricular function that resulted in left ventricular (LV) thrombus formation as a source of recurrent ischemic strokes. CASE REPORT A 36-year-old man had a 4-year history of recurrent strokes despite maintaining antiplatelet treatment. He had no pre-existing vascular risk factors or relevant family history. The initial stroke etiology work-up was inconclusive. A transesophageal echocardiogram showed moderate ventricular hypokinesia. A coronary angiogram was initiated, and a hypoplastic (LAD) artery anomaly was found. At first, the antiplatelet therapy was maintained. Later on, he presented with transient focal neurological symptoms indicative of a transient ischemic attack. Repeated echocardiograms detected left ventricular thrombus. Apixaban was started, with successful thrombus resolution in a one-month follow-up echocardiogram. He has not had a further recurrent ischemic event for 18 months. CONCLUSIONS This case suggests that CAAs might be considered as an associated etiology of ESUS in a young patient with recurrent cerebral events. In a clinical setting, we encourage early use of advanced cerebral and cardiac imaging modalities to accurately determine the stroke etiology, target the appropriate treatment, and prevent a further neurological sequel.
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Affiliation(s)
- Alia Ali Alokley
- Department of Neurology, King Fahad Hospital of the University, Al-Khobar, Saudi Arabia.,Department of Neurology, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Aishah Albakr
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed Almansori
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Cardiac-CT with the newest CT scanners: An incoming screening tool for competitive athletes? Clin Imaging 2021; 78:74-92. [PMID: 33773447 DOI: 10.1016/j.clinimag.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 02/18/2021] [Accepted: 03/05/2021] [Indexed: 11/20/2022]
Abstract
Competitive athletes of all skill levels are at risk of sudden cardiac death (SCD) due to certain heart conditions. Prior to engagement in high-intensity athletics, it is necessary to screen for these conditions in order to prevent sudden cardiac death. Cardiac-CT angiography (CCTA) is a reliable tool to rule out the leading causes of SCD by providing an exceptional overview of vascular and cardiac morphology. This allows CCTA to be a powerful resource in identifying cardiac anomalies in selected patients (i.e. unclear symptoms or findings at ECG or echocardiography) as well as to exclude significant coronary artery disease (CAD). With the advancement of technology over the last few years, the latest generations of computed tomography (CT) scanners provide better image quality at lower radiation exposures. With the amount of radiation exposure per scan now reaching the sub-millisievert range, the number of CT examinations it is supposed to increase greatly, also in the athlete's population. It is thus necessary for radiologists to have a clear understanding of how to make and interpret a CCTA examination so that these studies may be performed in a responsible and radiation conscious manner especially when used in the younger populations. Our work aims to illustrate the main radiological findings of CCTAs and highlight their clinical impact with some case studies. We also briefly describe critical features of state-of-the-art CT scanners that optimize different acquisitions to obtain the best quality at the lowest possible dose.
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Salehi S, Suri K, Najafi MH, Assadi M, Hosseini Toudeshki EA, Sarmast Alizadeh N, Gholamrezanezhad A. Computed Tomography Angiographic Features of Anomalous Origination of the Coronary Arteries in Adult Patients: A Literature Review and Coronary Computed Tomography Angiographic Illustrations. Curr Probl Diagn Radiol 2021; 51:204-216. [PMID: 33526366 DOI: 10.1067/j.cpradiol.2020.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022]
Abstract
Computed tomography angiography not only detects atherosclerotic coronary artery disease but also helps delineate the anomalous coronary arterial anatomy that may be more than just an incidental finding and could contribute to patients' symptomatology. Additionally, identification of coronary artery anomalies is clinically significant for preoperative planning and optimizing the approach for coronary catheterizations or surgical treatments. In this work, we review rare origination anomalies of coronary arteries and illustrate their characteristics through computed tomography images.
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Affiliation(s)
- Sana Salehi
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA.
| | - Kabir Suri
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA
| | | | - Majid Assadi
- The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Science, Bushehr, Iran
| | | | | | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA
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Ashraf S, Salman SH, Ali N, Kulshreshtha S, Saad M. A Rare Presentation of Angina and Arrhythmia in Absent Left Main Coronary Artery. Cureus 2020; 12:e12142. [PMID: 33489554 PMCID: PMC7811751 DOI: 10.7759/cureus.12142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Coronary artery anomalies (CAAs) are congenital disorders with multiple variations in the number, shape, and location of the Ostia of the coronary arterial system. The congenitally absent left main coronary artery (LMCA) is a rare anomaly that can present with benign or fatal complications ahead in life. Diagnosis and management of CAAs are sometimes challenging in low-risk patients. We present a unique case report of a 69-year-old Hispanic female who presented to the hospital with exercise-induced arrhythmia and angina symptoms. The patient complained of several episodes of chest pain, dizziness, and palpitations for a duration of two months. Electrocardiogram (EKG) and nuclear stress tests were equivocal. The angiogram revealed the separate origin of the left anterior descending artery (LAD) and left circumflex coronary artery (LCX) from the left coronary sinus. This anomaly should be considered in differentials when evaluating patients with angina symptoms. Congenital absence of LMCA is a rare condition that remains asymptomatic in the majority of the cases. It can present with exertional chest pain, palpitations, syncope, and sudden cardiac death (SCD). Occurrences of angina and arrhythmia should be carefully evaluated, and symptoms should be followed up closely. A coronary angiogram and electrophysiological testing can assist in the diagnosis.
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20
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(An anomalous origin and course of left anterior descending artery). COR ET VASA 2020. [DOI: 10.33678/cor.2020.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Harky A, Noshirwani A, Karadakhy O, Ang J. Comprehensive literature review of anomalies of the coronary arteries. J Card Surg 2019; 34:1328-1343. [DOI: 10.1111/jocs.14228] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Amer Harky
- Department of Cardiothoracic SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Arish Noshirwani
- Department of Cardiothoracic SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | | | - Juliana Ang
- School of MedicineUniversity of LiverpoolLiverpool UK
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Schicchi N, Fogante M, Giuseppetti GM, Giovagnoni A. Diagnostic detection with cardiac tomography and resonance of extremely rare coronary anomaly: A case report and review of literature. World J Clin Cases 2019; 7:628-635. [PMID: 30863762 PMCID: PMC6406198 DOI: 10.12998/wjcc.v7.i5.628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/09/2019] [Accepted: 01/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The association of two congenital coronary artery anomalies (CAAs) is extremely rare but represents one of the main cause of sudden cardiac death in young athletes. Although coronary angiography (CX-A) is still widely used in childhood, cardiac magnetic resonance (C-MRI) and cardiac computed tomography (C-CT) have recently taken on an increasing diagnostic role in early detection of CAAs and concomitant congenital cardiac malformations.
CASE SUMMARY A healthy 10-year-old male patient was referred to the Radiological Department of our Institution due to no evidence of left coronary artery in echocardiographic examination. With C-MRI was detected marked myocardial trabeculation and was suspected anomalous origin and course of left circumflex (LCx) artery and of left anterior descending (LAD) artery. With third generation Dual Source C-CT 192x2-sections (SOMATOM Force, Siemens, Germany) was confirmed anomalous origin of LCx artery from right pulmonary artery associated with anomalous origin of LAD artery from right coronary artery with course in front of right ventricular outflow tract. The patient underwent surgical treatment with reimplantation of the anomalous LCX and LAD arteries into the wall of ascending aorta, with no postoperative complications. The patient remained asymptomatic and follow-up C-MRI scan four months after operation showed complete success of surgery treatment.
CONCLUSION This case highlights the diagnostic potential of C-CT and C-MRI in evaluation of CAAs and of cardiac morphology and functionality, with very low radiation dose and without the risks related to invasive procedure.
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Affiliation(s)
- Nicolò Schicchi
- Department of Radiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona 60126, Italy
| | - Marco Fogante
- Department of Radiology, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Gian Marco Giuseppetti
- Department of Radiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona 60126, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona 60126, Italy
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Most AK, Bauer T, Nef H, Hamm C, Bauer P. Malignant anomalous origin of circumflex artery in an elite athlete. Clin Res Cardiol 2018; 108:719-721. [PMID: 30560380 DOI: 10.1007/s00392-018-1406-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Astrid Kerstin Most
- Department of Cardiology and Angiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany.
| | - Timm Bauer
- Department of Cardiology and Angiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
| | - Holger Nef
- Department of Cardiology and Angiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
| | - Christian Hamm
- Department of Cardiology and Angiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
| | - Pascal Bauer
- Department of Cardiology and Angiology, University Hospital Giessen, Klinikstraße 33, 35390, Giessen, Germany
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Yousif N, Shahin M, Manka R, Obeid S. Extensively Thrombosed Ectatic Circumflex Coronary Artery Fistula Presenting as Acute Coronary Syndrome. Curr Cardiol Rev 2018; 15:316-319. [PMID: 30520380 PMCID: PMC8142356 DOI: 10.2174/1573403x15666181206120138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 12/03/2018] [Accepted: 12/30/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Coronary artery fistula (CAF) is an abnormal communication between the termination of a coronary artery or its branches and a cardiac chamber, a great vessel or other vascular structure. Symptomatic patients with large CAF should undergo surgical or percutanous closure of the fistula at the drainage site while still the debate on closing asymptomatic CAF and re-opening symptomatic occluded CAF is ongoing.
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Affiliation(s)
- Nooraldaem Yousif
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Mohammady Shahin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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25
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Kastellanos S, Aznaouridis K, Vlachopoulos C, Tsiamis E, Oikonomou E, Tousoulis D. Overview of coronary artery variants, aberrations and anomalies. World J Cardiol 2018; 10:127-140. [PMID: 30386490 PMCID: PMC6205847 DOI: 10.4330/wjc.v10.i10.127] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/12/2018] [Accepted: 08/31/2018] [Indexed: 02/06/2023] Open
Abstract
Coronary artery anomalies and variants are relatively uncommon congenital disorders of the coronary artery anatomy and constitute the second most common cause of sudden cardiac death in young competitive athletes. The rapid advancement of imaging techniques, including computed tomography, magnetic resonance imaging, intravascular ultrasound and optical coherence tomography, have provided us with a wealth of new information on the subject. Anomalous origin of a coronary artery from the contralateral sinus is the anomaly most frequently associated with sudden cardiac death, in particular if the anomalous coronary artery has a course between the aorta and the pulmonary artery. However, other coronary anomalies, like anomalous origin of the left coronary artery from the pulmonary artery, atresia of the left main stem and coronary fistulae, have also been implicated in cases of sudden cardiac death. Patients are usually asymptomatic, and in most of the cases, coronary anomalies are discovered incidentally during coronary angiography or on autopsy following sudden cardiac death. However, in some cases, symptoms like angina, syncope, heart failure and myocardial infarction may occur. The aims of this article are to present a brief overview of the diverse coronary variants and anomalies, focusing especially on anatomical features, clinical manifestations, risk of sudden cardiac death and pathophysiologic mechanism of symptoms, as well as to provide valuable information regarding diagnostic workup, follow-up, therapeutic choices and timing of surgical treatment.
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Affiliation(s)
- Stylianos Kastellanos
- Cardiology Department, Castle Hill Hospital, Hull and East Yorkshire NHS Trust, Cottingham HU16 5JQ, United Kingdom
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1 Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Konstantinos Aznaouridis
- Cardiology Department, Castle Hill Hospital, Hull and East Yorkshire NHS Trust, Cottingham HU16 5JQ, United Kingdom
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1 Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece.
| | - Charalambos Vlachopoulos
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1 Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Eleftherios Tsiamis
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1 Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Evangelos Oikonomou
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1 Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Dimitris Tousoulis
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1 Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
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Anatomical variants and coronary anomalies detected by dual-source coronary computed tomography angiography in North-eastern Thailand. Pol J Radiol 2018; 83:e372-e378. [PMID: 30655913 PMCID: PMC6334062 DOI: 10.5114/pjr.2018.78420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose Congenital coronary anomalies are uncommon, with an incidence ranging from 0.17% in autopsy cases to 1.2% in angiographically evaluated cases. The recent development of dual-source coronary computed tomography angiography (coronary CTA) allows accurate and noninvasive depiction of coronary artery anomalies. Material and methods A retrospective study included a total of 924 patients who underwent coronary CTA because of known or suspected coronary artery disease. In each study, coronary artery anomalies (CAs) were investigated. Results A total of 924 patients (mean age 51.2 ± 12.8 years), who underwent dual-source coronary CTA, were studied. The overall prevalence of CAs in our study was 3.7%, with the following distribution: four single coronary artery, 14 anomalous origin from opposite sinus of Valsalva, three absent left main, four high take-off coronary artery, three anomalous left coronary artery from pulmonary artery, and eight coronary artery fistulas. Conclusions The present study supports the use of coronary CTA as a reliable noninvasive tool for defining anomalous coronary arteries in an appropriate clinical setting and provides detailed three-dimensional anatomic information that may be difficult to obtain with invasive coronary angiography.
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27
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Tian Y, Yuan Y, Lu H, Xu L, Yang WX, Mu CW, Liu HB, Chen J, Dou KF, Tang YD, Yuan JQ, Wu YJ, Yan HB, Xu B, Qiao SB, Yang YJ, Gao RL, Qiu H. Analysis of anomalous origin of coronary arteries by coronary angiography in Chinese patients with coronary artery disease. Int J Cardiovasc Imaging 2018; 34:1331-1337. [DOI: 10.1007/s10554-018-1350-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/07/2018] [Indexed: 10/17/2022]
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Shaikh GA, Asad A, Ahmed SS. Anomalous Supradominant Left Circumflex Artery with Rare, Rudimentary Left Anterior Descending Artery. Cureus 2018; 10:e3189. [PMID: 30364854 PMCID: PMC6199144 DOI: 10.7759/cureus.3189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Anomalies pertaining to the coronary vasculature are rare and generally asymptomatic, however, they can pose life-threatening risks in the form of sudden cardiac arrests or myocardial ischemia. We present a rare anomaly of a supradominant left circumflex artery (LCX) and a rudimentary left anterior descending artery (LAD). The patient presented in our outpatient department (OPD) with complaints of occasional chest pain and dyspnea on exertion. An exercise tolerance test (ETT) was carried out, which was inconclusive and an electrocardiogram (EKG) revealed a sinus rhythm with a nonspecific ST segment. Due to these findings, an angiography was performed via the trans-radial route using a TIG 5 French catheter (Terumo Medical Corporation, NJ, US). Coronary angiography revealed codominance because of the presence of a rudimentary LAD, a normal right coronary artery (RCA), and an extremely large LCX. As there was no significant stenosis or atherosclerosis in the coronary arteries, pharmacological treatment was chosen. The patient was discharged in a medically stable condition with a routine follow-up planned after one month. The identification of this supradominant LCX is crucial for diagnosis in possible future circumstances of percutaneous coronary intervention or coronary artery bypass grafting operations, ultimately improving the success rate of invasive cardiac therapies.
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Affiliation(s)
| | - Ameema Asad
- Dow Medical College, Dow University of Health Sciences, Karachi, PAK
| | - Syed Saadan Ahmed
- Dow Medical College, Dow University of Health Sciences, Karachi, PAK
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Anomalous Coronary Artery Origin in a Young Patient with Marfan Syndrome. Case Rep Cardiol 2018; 2017:3861923. [PMID: 29430308 PMCID: PMC5752982 DOI: 10.1155/2017/3861923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/13/2017] [Accepted: 11/13/2017] [Indexed: 11/17/2022] Open
Abstract
Marfan syndrome is an autosomal dominant genetic disorder that affects connective tissue and is caused by mutations in the fibrillin 1 gene present at chromosome 15. Aortic aneurysm is its main complication, and along the dilation of the aorta root and its descending portion (60–100%), with secondary aortic insufficiency, it increases risk of acute aortic dissection and death. Coronary artery anomalies affect between 0.3% and 1.6% of the general population and are the second leading cause of sudden death in young adults, especially if the anomalous coronary passes through aorta and pulmonary artery. The anomalous origin of the left main coronary artery in the right Valsalva sinus has a prevalence of 0.02%–0.05% and is commonly related to other congenital cardiac anomalies, such as transposition of great vessels, coronary fistulas, bicuspid aortic valve, and tetralogy of Fallot. Its association with Marfan syndrome is not known, and there is no previous report in the literature. We describe here a case of a female with Marfan syndrome diagnosed with symptomatic anomalous origin of the left coronary artery in the right Valsalva sinus.
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30
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Viuff MH, Trolle C, Wen J, Jensen JM, Nørgaard BL, Gutmark EJ, Gutmark-Little I, Mortensen KH, Gravholt CH, Andersen NH. Coronary artery anomalies in Turner Syndrome. J Cardiovasc Comput Tomogr 2016; 10:480-484. [DOI: 10.1016/j.jcct.2016.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 07/30/2016] [Accepted: 08/03/2016] [Indexed: 01/15/2023]
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Mokrane FZ, Colleter R, Duchesne S, Gerard P, Savall F, Crubezy E, Guilbeau-Frugier C, Moreno R, Sewonu A, Rousseau H, Telmon N, Dedouit F. Old hearts for modern investigations: CT and MR for archaeological human hearts remains. Forensic Sci Int 2016; 268:14-24. [PMID: 27665272 DOI: 10.1016/j.forsciint.2016.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/20/2016] [Accepted: 08/29/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Among 800 burials dated between the 15th and 18th centuries and found in the center of Rennes (Brittany, France), a collection of five heart-shaped lead urns was discovered. This material was studied using classical methods (external study, autopsy and histology), and also modern imaging like computed tomography (CT), magnetic resonance (MR) before and after coronary opacification. The aim of this manuscript is to describe different steps of ancient soft tissues study, especially using imaging techniques. METHODS The study gathered various specialists: anthropologists, archeologists, forensic pathologists, radiologists, pathologic physicians, and physicists. Imaging techniques were performed, before and after coronary opacification. Finally, hearts were autopsied and different histological samples were analyzed. RESULTS Only heart n°2 was too damaged to be studied. Heart n°3 was considered as normal using all investigation techniques. The study of Hearts n°s 4 and 5 revealed dilated cardiomyopathy while Heart n°1 showed important signs of diffuse hypertrophic cardiomyopathy. Different fibro lipid plaques were identified using imaging techniques, and were confirmed by histology. CONCLUSIONS The study of archeological soft tissues using modern imaging is possible if the material is well-preserved. This type of research can uncover principal findings, allowing scientists to establish diseases of ancient times.
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Affiliation(s)
- F Z Mokrane
- Service de radiologie Rangueil Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 30052, 31059 Toulouse Cedex 9, France; Laboratoire A.M.I.S (Anthropobiologie Moléculaire et Imagerie de Synthèse) UMR5288 - Faculté de Médecine Purpan, 37 Allées Jules Guesde 31073, Toulouse Cedex 7, France.
| | - R Colleter
- Laboratoire A.M.I.S (Anthropobiologie Moléculaire et Imagerie de Synthèse) UMR5288 - Faculté de Médecine Purpan, 37 Allées Jules Guesde 31073, Toulouse Cedex 7, France; INRAP 37 rue du Bignon, CS67737, 35577 Cesson-Sévigné Cedex, France
| | - S Duchesne
- Laboratoire A.M.I.S (Anthropobiologie Moléculaire et Imagerie de Synthèse) UMR5288 - Faculté de Médecine Purpan, 37 Allées Jules Guesde 31073, Toulouse Cedex 7, France; INRAP 37 rue du Bignon, CS67737, 35577 Cesson-Sévigné Cedex, France
| | - P Gerard
- Laboratoire A.M.I.S (Anthropobiologie Moléculaire et Imagerie de Synthèse) UMR5288 - Faculté de Médecine Purpan, 37 Allées Jules Guesde 31073, Toulouse Cedex 7, France
| | - F Savall
- Laboratoire A.M.I.S (Anthropobiologie Moléculaire et Imagerie de Synthèse) UMR5288 - Faculté de Médecine Purpan, 37 Allées Jules Guesde 31073, Toulouse Cedex 7, France; Service de médecine légale Rangueil Toulouse 1 Avenue du professeur Jean Poulhès, TSA 30052, 31059 Toulouse Cedex 9, France
| | - E Crubezy
- Laboratoire A.M.I.S (Anthropobiologie Moléculaire et Imagerie de Synthèse) UMR5288 - Faculté de Médecine Purpan, 37 Allées Jules Guesde 31073, Toulouse Cedex 7, France
| | - C Guilbeau-Frugier
- Service d'anatomie pathologique Rangueil Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 30052, 31059 Toulouse Cedex 9, France
| | - R Moreno
- Service de radiologie Rangueil Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 30052, 31059 Toulouse Cedex 9, France; INSERM U1048 - Institut des Maladies Moléculaires et Cardiovasculaires (I2MC, INSERM U1048), CHU Rangueil, 1 Avenue Jean Poulhes - Bâtiment L3-BP 84225 31432 Toulouse Cedex 4, France
| | - A Sewonu
- Service de radiologie Rangueil Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 30052, 31059 Toulouse Cedex 9, France; INSERM U1048 - Institut des Maladies Moléculaires et Cardiovasculaires (I2MC, INSERM U1048), CHU Rangueil, 1 Avenue Jean Poulhes - Bâtiment L3-BP 84225 31432 Toulouse Cedex 4, France
| | - H Rousseau
- Service de radiologie Rangueil Toulouse, 1 Avenue du Professeur Jean Poulhès, TSA 30052, 31059 Toulouse Cedex 9, France; INSERM U1048 - Institut des Maladies Moléculaires et Cardiovasculaires (I2MC, INSERM U1048), CHU Rangueil, 1 Avenue Jean Poulhes - Bâtiment L3-BP 84225 31432 Toulouse Cedex 4, France
| | - N Telmon
- Laboratoire A.M.I.S (Anthropobiologie Moléculaire et Imagerie de Synthèse) UMR5288 - Faculté de Médecine Purpan, 37 Allées Jules Guesde 31073, Toulouse Cedex 7, France; Service de médecine légale Rangueil Toulouse 1 Avenue du professeur Jean Poulhès, TSA 30052, 31059 Toulouse Cedex 9, France
| | - F Dedouit
- Laboratoire A.M.I.S (Anthropobiologie Moléculaire et Imagerie de Synthèse) UMR5288 - Faculté de Médecine Purpan, 37 Allées Jules Guesde 31073, Toulouse Cedex 7, France; Centre universitaire romand de médecine légale, Chemin de la Vulliette 4, CH-1000 Lausanne 25, Switzerland
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Villa ADM, Sammut E, Nair A, Rajani R, Bonamini R, Chiribiri A. Coronary artery anomalies overview: The normal and the abnormal. World J Radiol 2016; 8:537-555. [PMID: 27358682 PMCID: PMC4919754 DOI: 10.4329/wjr.v8.i6.537] [Citation(s) in RCA: 189] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/21/2016] [Accepted: 03/16/2016] [Indexed: 02/06/2023] Open
Abstract
The aim of this review is to give a comprehensive and concise overview of coronary embryology and normal coronary anatomy, describe common variants of normal and summarize typical patterns of anomalous coronary artery anatomy. Extensive iconography supports the text, with particular attention to images obtained in vivo using non-invasive imaging. We have divided this article into three groups, according to their frequency in the general population: Normal, normal variant and anomaly. Although congenital coronary artery anomalies are relatively uncommon, they are the second most common cause of sudden cardiac death among young athletes and therefore warrant detailed review. Based on the functional relevance of each abnormality, coronary artery anomalies can be classified as anomalies with obligatory ischemia, without ischemia or with exceptional ischemia. The clinical symptoms may include chest pain, dyspnea, palpitations, syncope, cardiomyopathy, arrhythmia, myocardial infarction and sudden cardiac death. Moreover, it is important to also identify variants and anomalies without clinical relevance in their own right as complications during surgery or angioplasty can occur.
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Alexandrescu VA. Commentary: Myths and Proofs of Angiosome Applications in CLI: Where Do We Stand? J Endovasc Ther 2014; 21:616-24. [DOI: 10.1583/14-4692c.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Normal anatomy and variants of the venous cardiac system in MDCT coronary angiography. Radiol Med 2013; 118:1149-56. [PMID: 23716280 DOI: 10.1007/s11547-013-0924-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 01/26/2012] [Indexed: 10/26/2022]
Abstract
Three separate venous systems drain the blood returning from the heart walls. These veins are characterised by remarkable variability in terms of frequency, size and course. The knowledge of cardiac venous anatomy is of primary importance during interventional cardiac procedures that require catheterisation of cardiac veins. Some anatomical variants may hinder or contraindicate access to target veins. Coronary angiography (CA) with multidetector computed tomography (MDCT-CA) and multiplanar reformations (MPR), maximum intensity projection (MIP) and 3D reconstructions provides noninvasive visualisation of normal cardiac veins and anatomical variants. The purpose of this pictorial review is to describe by MDCT-CA the anatomy and main variants of the cardiac venous system.
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Laspas F, Roussakis A, Mourmouris C, Kritikos N, Efthimiadou R, Andreou J. Coronary artery anomalies in adults: Imaging at dual source CT coronary angiography. J Med Imaging Radiat Oncol 2013; 57:184-90. [DOI: 10.1111/j.1754-9485.2012.02428.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 03/27/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Fotios Laspas
- CT and MRI Department; ‘Hygeia’ Hospital; Athens; Greece
| | | | | | | | | | - John Andreou
- CT and MRI Department; ‘Hygeia’ Hospital; Athens; Greece
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Murillo H, Lane MJ, Punn R, Fleischmann D, Restrepo CS. Imaging of the Aorta: Embryology and Anatomy. Semin Ultrasound CT MR 2012; 33:169-90. [DOI: 10.1053/j.sult.2012.01.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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