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Revision as of 15:38, 4 September 2012

Editors in Chief: Eli Gelfand, M.D. and C. Michael Gibson, M.S., M.D.

Associate Editors in Chief: Arnoldas Giedrimas, M.D.

Overview

The diagnosis of a congenital anomaly in the coronary circulation is often may on coronary angiography, CMR, or CT angiography ^[1] ^[2]. Stress testing can be used to evaluate the functional risk of ischemia.

Specific Anomalies

Anomalous Origin of the Circumflex Artery

The origin is from the posterior aortic sinus
Retroaortic course
Posterior AV groove course

Anomalous Right Coronary Artery

Origin from left sinus of Valsalva
Origin from the left anterior descending artery (LAD)
- Can lead to MI, sudden cardiac death

Atypical origin of the Left Coronary Artery

The left coronary artery originates from the pulmonary artery in the Bland-White-Garland syndrome. This results in:

Low perfusion pressure
Hypoxemia
May lead to coronary artery steal, and left to right shunt

Atypical origin of the Left Anterior Descending Artery (LAD)

Aortic root
Right sinus of Valsalva, Right Coronary Artery (RCA)
- LAD course between aorta and PA may result in compression with exercise
- This variant is associated with Tetralogy of Fallot

Atypical origin of LCx

- Aortic root
- R sinus of Valsalva, RCA
  - course posterior to L ventricle, generally benign

Tetralogy of Fallot

- LAD may originate from RCA, courses across pulmonary outflow tract

Other Cogential Heart Diseases in which There Can Be An Anomalous Origin of the Coronary Arteries

Myocardial Bridge

References:

↑ Angelini P: Normal and anomalous coronary arteries: definitions and classification. Am Heart J 1989 Feb; 117(2): 418-34.
↑ Angelini P, Fairchild VD, eds: Coronary Artery Anomalies: A Comprehensive Approach. Lippincott, Williams & Wilkins; 1999.

Additional Reading

Moss and Adams' Heart Disease in Infants, Children, and Adolescents Hugh D. Allen, Arthur J. Moss, David J. Driscoll, Forrest H. Adams, Timothy F. Feltes, Robert E. Shaddy, 2007 ISBN 0781786843
Hurst's the Heart, Fuster V, 12th ed. 2008, ISBN 978-0-07-149928-6
Willerson JT, Cardiovascular Medicine, 3rd ed., 2007, ISBN 978-1-84628-188-4

Template:WikiDoc Sources

[1] Angelini P: Normal and anomalous coronary arteries: definitions and classification. Am Heart J 1989 Feb; 117(2): 418-34.

[2] Angelini P, Fairchild VD, eds: Coronary Artery Anomalies: A Comprehensive Approach. Lippincott, Williams & Wilkins; 1999.

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 '''Editors in Chief:''' Eli Gelfand, M.D. and C. Michael Gibson, M.S., M.D.

v t e Congenital malformations and deformations of circulatory system (Q20-Q28, 745-747)
Cardiac chambers and connections	Persistent truncus arteriosus - Double outlet right ventricle (Taussig-Bing syndrome) - Transposition of the great vessels (dextro, levo)
Cardiac septa	Ventricular septal defect - Atrial septal defect (Lutembacher's syndrome) - Atrioventricular septal defect (Ostium primum) - Tetralogy of Fallot - Eisenmenger's syndrome
Right: pulmonary and tricuspid valves	pulmonary valves (stenosis, insufficiency) - tricuspid valves (stenosis, atresia) - Ebstein's anomaly
Left: aortic and mitral valves	aortic valves (stenosis, insufficiency, bicuspid) - mitral valves (stenosis, regurgitation) - Hypoplastic left heart syndrome
Other congenital malformations of heart	Dextrocardia - Levocardia - Cor triatriatum
Great arteries	aorta (Patent ductus arteriosus, Aortic coarctation, Interrupted aortic arch, Overriding aorta, Aneurysm of sinus of Valsalva, Vascular ring) - Pulmonary atresia
Great veins	Persistent left superior vena cava - Total anomalous pulmonary venous connection - Scimitar syndrome
Other	Arteriovenous malformation (Cerebral arteriovenous malformation)
See also non-congenital conditions (I, 390-459)