atypischer Verlauf der Koronararterien

Congenital coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. (a) Volume-rendered reconstruction showing myocardial bridge of the left anterior descending artery in a 65-year-old man who was referred for the exclusion of coronary artery disease. (b) Axial images revealing myocardial bridge with intramuscular course of the proximal left anterior descending artery between the left ventricular muscles.

Congenital

coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. (a) Volume-rendered reconstruction showing myocardial bridge of the left anterior descending artery in a 65-year-old man who was referred for the exclusion of coronary artery disease. (b) Axial images revealing myocardial bridge with intramuscular course of the proximal left anterior descending artery between the left ventricular muscles.

bmccardiovascdisord.biomedcentral.com • CC-by-2.0

Anomalous course of coronary arteries • Anomalous LAD - septal/subpulmonic course - Ganzer Fall bei Radiopaedia

Anomalous

course of coronary arteries • Anomalous LAD - septal/subpulmonic course - Ganzer Fall bei Radiopaedia

Kwong, Y. Anomalous LAD - septal/subpulmonic course. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-29600 • CC by-nc-sa 3.0 (modified)

Anomalous course of coronary arteries • Malignant interarterial course of the right coronary artery - Ganzer Fall bei Radiopaedia

Anomalous

course of coronary arteries • Malignant interarterial course of the right coronary artery - Ganzer Fall bei Radiopaedia

Kumar K, Malignant interarterial course of the right coronary artery. Case study, Radiopaedia.org (Accessed on 11 Jun 2023) https://doi.org/10.53347/rID-165625 • CC by-nc-sa 3.0 (modified)

Anomalous course of coronary arteries • Anomalous coronary arteries - Ganzer Fall bei Radiopaedia

Anomalous

course of coronary arteries • Anomalous coronary arteries - Ganzer Fall bei Radiopaedia

Saber, M. Anomalous coronary arteries. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-83979 • CC by-nc-sa 3.0 (modified)

Congenital coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. A patient with bland-white-garland syndrome (anomalous origin of the left coronary artery arising from the pulmonary artery) after cardiac surgery and replacement of origination. Volume-rendered images reveal now, corrected origination of the left coronary artery from the aorta with massive dilatation of the main stem (14.0 mm) and LAD (11.4 mm).

Congenital

coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. A patient with bland-white-garland syndrome (anomalous origin of the left coronary artery arising from the pulmonary artery) after cardiac surgery and replacement of origination. Volume-rendered images reveal now, corrected origination of the left coronary artery from the aorta with massive dilatation of the main stem (14.0 mm) and LAD (11.4 mm).

bmccardiovascdisord.biomedcentral.com • CC-by-2.0

Congenital coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. A patient with an anomalous origination of the right coronary artery (RCA). (a) Volume-rendered three-dimensional image showing that RCA is arising from the left coronary sinus with anomalous course between aorta and pulmonary trunk. (b) Axial images of the same patient showing the potentially malignant course of the RCA.

Congenital

coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. A patient with an anomalous origination of the right coronary artery (RCA). (a) Volume-rendered three-dimensional image showing that RCA is arising from the left coronary sinus with anomalous course between aorta and pulmonary trunk. (b) Axial images of the same patient showing the potentially malignant course of the RCA.

bmccardiovascdisord.biomedcentral.com • CC-by-2.0

Congenital coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. Volume-rendered three-dimensional reconstructions of the coronary tree and heart by CT coronary angiography in a patient presenting with previous syncope showing the circumflex artery arising from the right anterior sinus with anomalous retroaortic course.

Congenital

coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. Volume-rendered three-dimensional reconstructions of the coronary tree and heart by CT coronary angiography in a patient presenting with previous syncope showing the circumflex artery arising from the right anterior sinus with anomalous retroaortic course.

bmccardiovascdisord.biomedcentral.com • CC-by-2.0

A single, shared origin for all three coronary arteries from the right coronary cusp: a case report. Two views (a and b) from CCTA imaging revealing the left anterior descending artery originating posteriorly and coursing between the aorta and left atrium. CCTA coronary computed tomographic angiography

A single,

shared origin for all three coronary arteries from the right coronary cusp: a case report. Two views (a and b) from CCTA imaging revealing the left anterior descending artery originating posteriorly and coursing between the aorta and left atrium. CCTA coronary computed tomographic angiography

jmedicalcasereports.biomedcentral.com • CC-by-4.0

A single, shared origin for all three coronary arteries from the right coronary cusp: a case report. Left heart catheterization revealing anomalous coronary arteries all arising from the right coronary cusp. Green arrow: right coronary artery. Blue arrow: left anterior descending artery. Gray arrow: circumflex artery. Yellow arrow: origin of all three coronary arteries

A single,

shared origin for all three coronary arteries from the right coronary cusp: a case report. Left heart catheterization revealing anomalous coronary arteries all arising from the right coronary cusp. Green arrow: right coronary artery. Blue arrow: left anterior descending artery. Gray arrow: circumflex artery. Yellow arrow: origin of all three coronary arteries

jmedicalcasereports.biomedcentral.com • CC-by-4.0

Missed myocardial infarction in a vicenarian with malignant anomalous right coronary artery causing acute coronary syndrome: a case report. Multi-modality imaging of anomalous right coronary artery

Missed

myocardial infarction in a vicenarian with malignant anomalous right coronary artery causing acute coronary syndrome: a case report. Multi-modality imaging of anomalous right coronary artery

jmedicalcasereports.biomedcentral.com • CC-by-4.0

Anomalous course of coronary arteries • Malignant course of right coronary artery - Ganzer Fall bei Radiopaedia

Anomalous

course of coronary arteries • Malignant course of right coronary artery - Ganzer Fall bei Radiopaedia

Johnstone, A. Malignant course of right coronary artery. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-81599 • CC by-nc-sa 3.0 (modified)

Anomalous course of coronary arteries • Anomalous right coronary artery (ARCA) with interarterial course - Ganzer Fall bei Radiopaedia

Anomalous

course of coronary arteries • Anomalous right coronary artery (ARCA) with interarterial course - Ganzer Fall bei Radiopaedia

Ranschaert, E. Anomalous right coronary artery (ARCA) with interarterial course. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-12423 • CC by-nc-sa 3.0 (modified)

Anomalous course of coronary arteries • Transseptal course of left coronary artery - Ganzer Fall bei Radiopaedia

Anomalous

course of coronary arteries • Transseptal course of left coronary artery - Ganzer Fall bei Radiopaedia

Fischer, J. Transseptal course of left coronary artery. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-12891 • CC by-nc-sa 3.0 (modified)

Anomalous course of coronary arteries • Anomalous LCA with benign course - Ganzer Fall bei Radiopaedia

Anomalous

course of coronary arteries • Anomalous LCA with benign course - Ganzer Fall bei Radiopaedia

Hacking, C. Anomalous LCA with benign course. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-34977 • CC by-nc-sa 3.0 (modified)

Anomalous course of coronary arteries • Anomalous origin of LMCA off RCA with malignant course - Ganzer Fall bei Radiopaedia

Anomalous

course of coronary arteries • Anomalous origin of LMCA off RCA with malignant course - Ganzer Fall bei Radiopaedia

Hacking, C. Anomalous origin of LMCA off RCA with malignant course. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-35174 • CC by-nc-sa 3.0 (modified)

Anomalous course of coronary arteries • Myocardial bridging - Ganzer Fall bei Radiopaedia

Anomalous

course of coronary arteries • Myocardial bridging - Ganzer Fall bei Radiopaedia

Hacking, C. Myocardial bridging. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-37317 • CC by-nc-sa 3.0 (modified)

Anomalous course of coronary arteries • Right coronary artery intra-cavitary course - Ganzer Fall bei Radiopaedia

Anomalous

course of coronary arteries • Right coronary artery intra-cavitary course - Ganzer Fall bei Radiopaedia

Kwong, Y. Right coronary artery intra-cavitary course. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-30519 • CC by-nc-sa 3.0 (modified)

Anomalous course of coronary arteries • Anomalous left coronary artery: prepulmonic course - Ganzer Fall bei Radiopaedia

Anomalous

course of coronary arteries • Anomalous left coronary artery: prepulmonic course - Ganzer Fall bei Radiopaedia

Kwong, Y. Anomalous left coronary artery: prepulmonic course. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-29253 • CC by-nc-sa 3.0 (modified)

Anomalous course of coronary arteries • Anomalous origin of the circumflex artery with retro-aortic course - Ganzer Fall bei Radiopaedia

Anomalous

course of coronary arteries • Anomalous origin of the circumflex artery with retro-aortic course - Ganzer Fall bei Radiopaedia

Kwong, Y. Anomalous origin of the circumflex artery with retro-aortic course. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-27974 • CC by-nc-sa 3.0 (modified)

Congenital coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. A patient with angina pectoris underwent coronary angiography. Images reveal myocardial bridging in the mid LAD (a) during diastole and (b) during systole.

Congenital

coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. A patient with angina pectoris underwent coronary angiography. Images reveal myocardial bridging in the mid LAD (a) during diastole and (b) during systole.

bmccardiovascdisord.biomedcentral.com • CC-by-2.0

Anomalous course of coronary arteries • Tubular origin of right coronary artery - Ganzer Fall bei Radiopaedia

Anomalous

course of coronary arteries • Tubular origin of right coronary artery - Ganzer Fall bei Radiopaedia

Gilcrease-Garcia, B. Tubular origin of right coronary artery. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-59707 • CC by-nc-sa 3.0 (modified)

Anomalous course of coronary arteries • Right coronary artery arising from the pulmonary artery - Ganzer Fall bei Radiopaedia

Anomalous

course of coronary arteries • Right coronary artery arising from the pulmonary artery - Ganzer Fall bei Radiopaedia

Tigges S, Right coronary artery arising from the pulmonary artery. Case study, Radiopaedia.org (Accessed on 03 Aug 2023) https://doi.org/10.53347/rID-172747 • CC by-nc-sa 3.0 (modified)

Radiopaedia • CC-by-nc-sa 3.0 • de

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
kongenitale Fistelungen Koronararterien
intramyokardialer Verlauf der Koronararterien
retroaortaler Verlauf der linken Koronararterie
anomalous left main coronary arterial origin
Ursprung der LCX aus RCA
congenital atresia of the right coronary artery ostium
transseptaler Verlauf Koronarterie
arteriovenöse Fisteln der Koronarien

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.