atypischer Verlauf der Koronararterien

Anomalous course of a coronary artery is a type of congenital coronary artery anomaly. It may represent a benign and incidental finding, but rarely it is a malignant course predisposing patients to life-threatening myocardial ischemia or arrhythmias, depending on where the artery runs.

Clinical presentation

The majority (approximately 80%) of anomalous coronary artery courses are benign and asymptomatic. However, on rare occasions, it may result in ischemia, arrhythmias, or sudden death. Most symptomatic patients present at a young age.

Pathology

The coronary artery may pass between the aorta and the main pulmonary artery, representing a so-called interarterial course. It may be associated with a "slit-like" orifice in which an acute angle course at the ostium is more prone to occlusion. During physical activity, the artery may be compressed, and the flow within it may be compromised. The presence of a "slit-like" orifice or intramural course of the coronary artery within the aortic wall is more predictive of adverse outcome than the interarterial course alone.

There are four common courses for an anomalous coronary artery arising from the opposite sinus :

• malignant course
  • interarterial right or left (i.e. between the aorta and the pulmonary artery): this is the most dangerous as it carries a high risk of sudden cardiac death
• benign course
  • retroaortic coronary course
  • prepulmonic coronary course
  • septal (subpulmonic)

Treatment and prognosis

The treatment of anomalous coronary arteries is controversial. Mainly patients with a benign course rarely need surgical treatment. Symptomatic patients with an interarterial course may require surgical "re-implantation" of the anomalous coronary artery or "de-roofing" if an intramural course is present.

Siehe auch:

• Normvarianten Koronararterien
• interarterieller Verlauf der RCA
• separater Abgang von LAD und LCX
• Bland-White-Garland-Syndrom
• intraatrialer Verlauf der RCA
• interarterieller Verlauf der linken Koronararterie
• anterior interventricular branch of left coronary artery
• anomalous/"malignant" origin of coronary artery
• retroaortaler Verlauf der linken Koronararterie
• kongenitale Fistelungen Koronararterien
• anomalous left main coronary arterial origin
• Fistelungen Koronararterien
• intramyokardialer Verlauf der Koronararterien
• Ursprung der LCX aus RCA
• congenital atresia of the right coronary artery ostium
• transseptaler Verlauf Koronarterie

und weiter:

• linke Koronararterie
• rechte Koronararterie
• Koronararterien