Congenital anomalies of the coronary circulation
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