Anomalous origin of the left coronary artery from the pulmonary artery in an adult with systemic collateral circulation to the left coronary artery

Anomalies of coronary artery origin: Evaluation on multidetector CT angiography

Anomalies of origin of coronary arteries are an uncommon occurrence and found in approximately 1-2% of the general population. While a large proportion of these anomalies are clinically silent, a few might be hemodynamically significant and may even result in sudden cardiac death. Comprehensive knowledge of the normal as well as variant anatomies of the coronary artery origin and familiarity with imaging appearances and clinical significance of these anomalies is imperative for precise diagnosis and subsequent planning of treatment, whenever required. Multidetector computed tomography angiography, on account of its non-invasiveness, faster scan times and multiplanar reconstruction capabilities, is increasingly being utilized for characterization of coronary artery origin anomalies and their three-dimensional spatial relations. It shows a superior rate of detection of these anomalies compared to conventional angiography, providing more accurate delineation of the ostium as well as course. With the advent of newer generation CT scanners and use of advanced dose reduction techniques, images can be obtained rapidly having excellent spatial resolution and with minimal radiation dose. In this review article, we present the multidetector CT angiography imaging findings of the spectrum of anomalous coronary artery origin, using a third-generation dual-source CT scanner.

A case of anomalous left coronary artery arising from the pulmonary artery in adulthood: multidetector computed tomography coronary angiography findings

Anomalous left coronary artery arising from the pulmonary artery (ALCAPA) is a rare but very serious congenital coronary artery anomaly. Multidetector computed tomography (MDCT) coronary angiography has recently become the gold standard for depicting anatomical variations and anomalies of the coronary arteries because the origin and course of anomalous arteries can be demonstrated very accurately by this technique. In this report, we present a case of 22-year-old female who was admitted to our emergency department with cardiac arrest. In the course of diagnosis, MDCT coronary angiography revealed a left coronary artery arising from the pulmonary artery as well as marked dilatation of the coronary arteries.

Congenital coronary arteries anomalies: review of the literature and multidetector computed tomography (MDCT)-appearance

The prevalence of coronary arteries congenital anomalies is 1 to 2% in the general population. Although the spectrum of their clinical manifestations is very broad from total inocuity to lethal, anomalies of coronary arteries need to be recognized by clinicians in certain circumstances: they are the first cause of death in young adults under physical exercise and an abnormal course of a coronary artery can complicate a cardiac surgery. Therefore, a non-invasive test is highly suitable for detecting anomalies of coronary arteries and multidetector computed tomography (MDCT) is likely to be the best one. To understand how anomalies of coronary arteries may occur, we have reviewed the recent literature about their development. Then, the main types of anomalies are presented with their clinical context, and representative MDCT images from our personal database are used for illustration.

Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation

Congenital abnormalities of the coronary arteries are an uncommon but important cause of chest pain and, in some cases of hemodynamically significant abnormalities, sudden cardiac death. For several decades, premorbid diagnosis of coronary artery anomalies has been made with conventional angiography. However, this imaging technique has limitations due to its projectional and invasive nature. The recent development of electrocardiographically (ECG)-gated multi-detector row computed tomography (CT) allows accurate and noninvasive depiction of coronary artery anomalies of origin, course, and termination. Multi-detector row CT is superior to conventional angiography in delineating the ostial origin and proximal path of an anomalous coronary artery. Familiarity with the CT appearances of various coronary artery anomalies and an understanding of the clinical significance of these anomalies are essential in making a correct diagnosis and planning patient treatment.