Retroaortic epicardial course of the left circumflex coronary artery and anteroaortic intramyocardial (ventricular septum) course of the left anterior descending coronary artery: an unusual coronary anomaly and a proposed classification based on the number of coronary ostia in the aorta

The normal and abnormal anatomy of the coronary arteries

Beneficial therapeutic options are increasingly available for coronary arterial disease. To take full advantage of these options, those performing the interventions require a thorough knowledge of the normal arrangement, and likely anatomic variations, of the coronary arterial system. A comprehensive appreciation of the architecture of the coronary arterial system, therefore, is crucial to optimal cardiac care. Simple attention to potential variations in the origin and course of the major coronary arteries can greatly enhance clinical outcomes. The objective of this review, therefore, is to describe the normal anatomical distribution of the coronary arteries in the human heart, and to list the most common arterial variations.

Anomalous origin of the entire coronary system with separate ostia within the right sinus of valsalva: a rare congenital anomaly and a review of the literature

Congenital coronary artery malformations occur infrequently in the general population. In this report, we describe a rare case of anomalous origin of all three coronary arteries from separate ostia within the right coronary sinus.

Anomalous origin of the three coronary arteries from the right aortic sinus Valsalva: role of MDCT coronary angiography

BACKGROUND

Monocuspal origin of all three coronary arteries through separate ostia from the right aortic sinus (RCS) is a rare occurrence. To date, the use of multidetector computed tomography (MDCT) for imaging of congenitally abnormal coronary arteries has been discussed only in few individual case reports.

OBJECTIVE

To describe the role of MDCT coronary angiography in the evaluation of two rare cases of monocuspal origin of all three coronary from RCS.

PATIENTS AND METHODS

We had a retrospective review of clinical information and imaging studies for two patients presented with chest pain. Both patients underwent conventional coronary angiography followed by noninvasive imaging with MDCT.

RESULTS

Both patients had anomalous origin of the all three coronary arteries from the RCS. In one case the LAD took an intramural course in between the aorta and the right ventricular outflow tract (RVOT) while it passed anterior to the RVOT in the other patient. In the first patient, there was also associated coronary fistula to the right ventricle along with right coronary artery (RCA) and left anterior descending coronary artery (LAD) narrowing. Both the stenosed segments were successfully stented and were demonstrated to be patent in the subsequent MDCT.

CONCLUSION

Monocuspal origin of all three coronary artery from the RCS is a rare anomaly, can be reliably diagnosed by MDCT. CT angiogram is a convenient complementary tool for the coronary arteriography.

Anomalous origins of the left coronary arteries from the right sinus of valsalva with an unusual course

We report and attempt to classify a previously undescribed coronary artery anomaly. Our patient had all three coronary arteries arising from a common ostium in the right sinus of Valsalva, with an unusual distribution to the left coronary artery system: the anomalous left circumflex system taking an intraseptal (intramyocardial) course and the anomalous left anterior descending system taking an interarterial (between the great vessels) course.