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Bruna-Mejias A, del Villar-Valdebenito J, Roman C, Alcaíno-Adasme C, Sepulveda-Loyola W, Orellana-Donoso M, Nova-Baeza P, Suazo-Santibañez A, Becerra-Farfan A, Sanchis-Gimeno J, Valenzuela-Fuenzalida JJ. Hypoplastic and Congenital Absence of Coronary Arteries and Its Correlation with Clinical Implications of Cardiac Circulation: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3085. [PMID: 38892796 PMCID: PMC11173156 DOI: 10.3390/jcm13113085] [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: 04/18/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Coronary arteries originate from the first portion of the aorta, emerging from the right and left aortic sinuses. They traverse through the subepicardium and coronary sulcus to supply the myocardium during diastolic function. The objective of this review was to understand how the hypoplasia and agenesis of the coronary arteries are associated with cardiac pathologies. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were researched until January 2024. An assurance tool for anatomical studies (AQUA) was used to evaluate methodological quality. The pooled prevalence was estimated using a random effects model. Results: A total of three studies met the established selection criteria for inclusion in this meta-analysis. The prevalence of coronary artery variants was 3% (CI = 2% to 8%), with a heterogeneity of 77%. The other studies were analyzed descriptively, along with their respective clinical considerations in the presence of the variant. Conclusions: Hypoplasia and the congenital absence of the coronary arteries are often incidental findings and understanding these variants is crucial to prevent misdiagnosis. Additionally, it is essential to exercise caution when considering surgical management for hearts with these variants.
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Affiliation(s)
- Alejandro Bruna-Mejias
- Departamento de Ciencias y Geografía, Facultad de Ciencias Naturales y Exactas, Universidad de Playa Ancha, Valparaiso 2360072, Chile;
| | | | - Camila Roman
- Department of Morphology, Faculty of Medicine, Universidad Andres Bello, Santiago 7500735, Chile; (C.R.); (C.A.-A.); (P.N.-B.)
| | - Catalina Alcaíno-Adasme
- Department of Morphology, Faculty of Medicine, Universidad Andres Bello, Santiago 7500735, Chile; (C.R.); (C.A.-A.); (P.N.-B.)
| | - Walter Sepulveda-Loyola
- Faculty of Health Sciences, Universidad de las Américas, Santiago 8320000, Chile; (W.S.-L.); (A.S.-S.)
| | - Mathias Orellana-Donoso
- Department of Morphological Sciences, Faculty of Medicine and Science, Universidad San Sebastián, Santiago 8420524, Chile;
- Escuela de Medicina, Universidad Finis Terrae, Santiago 7501015, Chile
| | - Pablo Nova-Baeza
- Department of Morphology, Faculty of Medicine, Universidad Andres Bello, Santiago 7500735, Chile; (C.R.); (C.A.-A.); (P.N.-B.)
| | | | - Alvaro Becerra-Farfan
- Departamento de Ciencias Química y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O’Higgins, Santiago 8320000, Chile;
| | - Juan Sanchis-Gimeno
- GIAVAL Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, 46001 Valencia, Spain;
| | - Juan José Valenzuela-Fuenzalida
- Department of Morphology, Faculty of Medicine, Universidad Andres Bello, Santiago 7500735, Chile; (C.R.); (C.A.-A.); (P.N.-B.)
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2
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Barman P, John A. Novel Anatomical Variation of Left Coronary Artery Origin at the Sinotubular Junction Level With Coeval Hypoplastic Left Circumflex, Superdominant Right Coronary Artery, and Obstructive Coronary Artery Disease: A Case Report. Cureus 2024; 16:e59715. [PMID: 38841027 PMCID: PMC11151146 DOI: 10.7759/cureus.59715] [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] [Received: 03/22/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
The isolated origin of the left coronary artery (LCA) ostium at the level of the sinotubular junction (STJ) has been described previously. Congenital absence of the left circumflex (LCx) coronary artery has also been documented with superdominant right coronary arterial circulation, either in the presence or absence of coronary artery obstruction. Earlier literature has linked the association of an absent LCx coronary artery with a superdominant right coronary artery (SRCA) but not with a hypoplastic LCx coronary artery (HLCx). The present case report details the case of a 37-year-old thin, athletic male with the risk factors of diabetes and hypertension who was admitted to the emergency unit of our hospital for losing consciousness while bicycling in the street. The current report establishes a combined association of LCA anomaly origin at STJ level along with HLCx and SRCA condition with the burden of mild to moderate coronary artery disease involving proximal left anterior descending artery, LCx, and mid right coronary artery in the literature for the first time. Further, the case report advocated that the presented case carries the risk of malignancy. Hence, with the advancement of modern imaging technologies, computed tomography angiography should be the first choice of imaging modality rather than coronary angiography to prevent fatal outcomes. Interventional cardiologists, cardiothoracic surgeons, and radiologists should have properly defined knowledge of coronary artery anatomy and associated pathology, as it is important for coronary cannulation or any coronary interventions.
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Affiliation(s)
- Parishmita Barman
- Department of Radiology, Sree Balaji Medical College & Hospital, Chennai, IND
| | - Andrew John
- Department of Radiology, Kiran Multi Super Speciality Hospital & Research Centre, Surat, IND
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Zamfir AS, Stătescu C, Sascău RA, Tinică G, Zamfir CL, Cernomaz TA, Chistol RO, Boișteanu D, Sava A. Casting Light on The Hidden Prevalence: A Novel Perspective on Hypoplastic Coronary Artery Disease. J Clin Med 2024; 13:2555. [PMID: 38731084 PMCID: PMC11084682 DOI: 10.3390/jcm13092555] [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: 03/18/2024] [Revised: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background and Objectives: Coronary artery anomalies (CAAs) represent a group of rare cardiac abnormalities with an incidence of up to 1.2%. The aim of this retrospective study was to conduct a comprehensive epidemiological assessment of the prevalence of hypoplastic coronary arteries using coronary computed tomography angiography (CCTA) in patients with diagnosed CAAs and individuals presenting with cardiovascular manifestations in the north-eastern region of Romania. This study was motivated by the limited investigation of the CAAs conducted in this area. Methods: We analyzed data collected from 12,758 coronary computed tomography angiography (CCTA) records available at the "Prof. Dr. George I.M. Georgescu" Cardiovascular Diseases Institute, spanning the years 2012 to 2022. Results: Among 350 individuals with CAAs (2.7% of the total cohort), 71 patients (20.3% of the anomaly presenting group and 0.5% of the entire CCTA cohort) exhibited at least one hypoplastic coronary artery. The mean age of individuals diagnosed with hypoplastic coronary artery disease (HCAD) was 61 years, while the age distribution among them ranged from 22 to 84 years. Nearly equal cases of right and left dominance (33 and 31, respectively) were observed, with only 7 cases of co-dominance. Conclusions: HCAD may be considered underexplored in current published research, despite its potentially significant implications ranging to an increased risk of sudden cardiac arrest. The specific prevalence of HCAD among CAAs might be higher than previously reported, possibly reflecting better diagnostic accuracy of CCTA over classic coronary imaging. The absence of standard diagnostic and therapeutic protocols for HCAD underscores the necessity of a personalized approach for such cases.
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Affiliation(s)
- Alexandra-Simona Zamfir
- Clinical Hospital of Pulmonary Diseases, 700115 Iași, Romania
- Department of Medical Sciences III, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Cristian Stătescu
- Department of Medical Sciences I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Cardiology Department, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, 700503 Iași, Romania
| | - Radu Andy Sascău
- Department of Medical Sciences I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Cardiology Department, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, 700503 Iași, Romania
| | - Grigore Tinică
- Department of Surgery I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Cardiovascular Surgery, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, 700503 Iași, Romania
| | - Carmen Lăcrămioara Zamfir
- Department of Morpho-Functional Sciences I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Tudor-Andrei Cernomaz
- Department of Medical Sciences III, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Regional Institute of Oncology, 700483 Iași, Romania
| | - Raluca Ozana Chistol
- Department of Morpho-Functional Sciences I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Medical Imaging, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, 700503 Iași, Romania
| | - Daniela Boișteanu
- Clinical Hospital of Pulmonary Diseases, 700115 Iași, Romania
- Department of Medical Sciences III, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Anca Sava
- Department of Morpho-Functional Sciences I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Pathology, “Prof. Dr. Nicolae Oblu” Emergency Clinical Hospital, 700309 Iaşi, Romania
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Dotka M, Małek ŁA. Myocardial Infarction in Young Athletes. Diagnostics (Basel) 2023; 13:2473. [PMID: 37568836 PMCID: PMC10417275 DOI: 10.3390/diagnostics13152473] [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: 06/15/2023] [Revised: 07/14/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
Myocardial infarction (MI) in young athletes is very rare but can have serious consequences, including sudden cardiac death (SCD), an increased proarrhythmic burden in future life, and/or heart failure. We present two cases of young athletes with MI. They did not have previous symptoms, traditional risk factors, or a family history of MI. One case involves a 37-year-old male amateur athlete who experienced two MI following intense physical exertion, likely due to the erosion of an insignificant atherosclerotic plaque caused by a sudden increase in blood pressure during exercise. The second case describes a 36-year-old male semi-professional runner who collapsed at the finish line of a half-marathon and was diagnosed with hypertrophic cardiomyopathy. The heart's oxygen demand-supply mismatch during intensive exercise led to MI. Following the case presentation, we discuss the most common causes of MI in young athletes and their mechanisms, including spontaneous coronary artery dissection, chest trauma, abnormalities of the coronary arteries, coronary artery spasm, plaque erosion, hypercoagulability, left ventricular hypertrophy, and anabolic steroids use.
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Affiliation(s)
- Mariusz Dotka
- Faculty of Medicine, Poznan University of Medical Sciences, 61-701 Poznań, Poland;
| | - Łukasz A. Małek
- Faculty of Rehabilitation, University of Physical Activity in Warsaw, 01-968 Warsaw, Poland
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Sangita M, Yadav J, Chaurasia JK, Arora A, Jahan A, Patnaik M. Hypoplastic coronary artery disease, as a cause of sudden death. Autops Case Rep 2023; 13:e2023440. [PMID: 37635733 PMCID: PMC10449246 DOI: 10.4322/acr.2023.440] [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] [Received: 10/31/2022] [Accepted: 06/20/2023] [Indexed: 08/29/2023]
Abstract
Hypoplastic coronary artery disease (HCAD) is a rare coronary artery anomaly that may be the cause of sudden death. It can involve a single or all coronary arteries. This anomaly may cause circulatory insufficiency leading to myocardial infarction. HCAD has no symptoms or may exhibit cardiovascular signs like syncope, dyspnea, chest discomfort, or dizziness. It is often diagnosed at autopsy, and early diagnosis is made with a coronary angiogram. We report HCAD as the cause of the sudden death of a 25-year-old female with a history of loss of consciousness following exertion. On autopsy, all the coronary arteries' lumen was narrowed with thin vessel walls. Histopathological examination shows an underdeveloped and missing muscular layer of the left anterior descending and circumflex coronary arteries' vascular wall. Many cases of HCAD diagnosed by radiographic imaging in living patients have been reported in the literature, but a structural anomaly of coronaries leading to HCAD has not been reported. We report a case of HCAD describing the histopathological examination findings of the vascular wall of coronary vessels illustrating the structural difference.
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Affiliation(s)
- Moirangthem Sangita
- All India Institute Medical Sciences, Bhopal, Forensic Medicine and Toxicology, Bhopal, India
| | - Jayanthi Yadav
- All India Institute Medical Sciences, Bhopal, Forensic Medicine and Toxicology, Bhopal, India
| | - Jai Kumar Chaurasia
- All India Institute Medical Sciences, Bhopal, Pathology and Lab Medicine, Bhopal, India
| | - Arneet Arora
- All India Institute Medical Sciences, Bhopal, Forensic Medicine and Toxicology, Bhopal, India
| | - Afsar Jahan
- All India Institute Medical Sciences, Bhopal, Forensic Medicine and Toxicology, Bhopal, India
| | - Mrinal Patnaik
- All India Institute Medical Sciences, Bhopal, Forensic Medicine and Toxicology, Bhopal, India
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Guo A, Bakhshi H, O'Hara J, Genovese L, Fein A, Maghsoudi A, Sandesara C. Hypoplastic Coronary Artery Disease Presenting with Ventricular Fibrillation Cardiac Arrest. Eur J Case Rep Intern Med 2021; 8:002736. [PMID: 34527617 DOI: 10.12890/2021_002736] [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: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 11/05/2022] Open
Abstract
Hypoplastic coronary artery disease is a rare congenital anomaly that may present with ischaemic heart disease, heart failure or sudden cardiac death (SCD). We describe a case of cardiac arrest in a healthy young man. Work-up revealed a hypoplastic left anterior descending artery. The patient underwent cardioverter-defibrillator implantation for secondary prevention. LEARNING POINTS Hypoplastic coronary artery disease (HCAD) is a rare cause of cardiac arrest and should be suspected in cases of sudden cardiac death (SCD) in young adults.The mechanism in HCAD leading to ventricular fibrillation cardiac arrest is not well understood.Implantable cardioverter-defibrillator (ICD) implantation is recommended for secondary prevention of ventricular fibrillation.
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Affiliation(s)
- Abra Guo
- Department of Internal Medicine, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Hooman Bakhshi
- Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - James O'Hara
- Inova Heart and Vascular Institute, Falls Church, VA, USA.,Virginia Heart, Falls Church, VA, USA
| | | | - Adam Fein
- Inova Heart and Vascular Institute, Falls Church, VA, USA.,Virginia Heart, Falls Church, VA, USA
| | - Alireza Maghsoudi
- Inova Heart and Vascular Institute, Falls Church, VA, USA.,Virginia Heart, Falls Church, VA, USA
| | - Chirag Sandesara
- Inova Heart and Vascular Institute, Falls Church, VA, USA.,Virginia Heart, Falls Church, VA, USA
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A Rare Report of Hypoplastic Coronary Arteries and Pulmonary Veins: A Case Report and Review of the Literature. Pediatr Cardiol 2020; 41:1231-1237. [PMID: 32361881 DOI: 10.1007/s00246-020-02334-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
Congenital coronary artery anomalies are estimated to affect about 1% of the general population. Hypoplastic coronary artery disease is an uncommon subset associated with significant mortality regardless whether another major cardiac anomaly is present. In this case report, we present an extremely rare case of an infant with hypoplastic coronary artery disease and hypoplastic pulmonary veins. A literature review pertinent to the clinical findings is also contained herein.
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8
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Sayit AT, Celenk C. Hypoplastic Left Circumflex Coronary Artery: Imaging Findings with Coronary Computed Tomography Angiography - A Case Report. Curr Med Imaging 2019; 15:427-429. [DOI: 10.2174/1573405614666180111151623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 12/25/2017] [Accepted: 01/01/2018] [Indexed: 11/22/2022]
Abstract
<P>Background: Hypoplastic coronary artery disease is a rare congenital coronary artery anomaly. It is often detected incidentally, and its true incidence in the general population is not known. </P><P> Discussion: Symptoms of HCAD are syncope, palpitations, dyspnea, and chest pain. Also, arrhythmia and myocardial infarction can be seen; these can cause sudden death, especially in athletes and young people. Diagnosis is often made at autopsy.Conclusion:Here, we present the case of a 39-year-old male with isolated hypoplasia of the left circumflex artery detected by coronary Computed Tomography (CT) angiography who complained of palpitation.</P>
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Affiliation(s)
| | - Cetin Celenk
- Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Hypoplastic left coronary artery with large collateral vessels from an ectatic right coronary artery. Int J Cardiol 2014; 172:e396-7. [DOI: 10.1016/j.ijcard.2013.12.261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 12/30/2013] [Indexed: 11/18/2022]
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