Normvarianten Koronararterien
Intraatrialer
Verlauf der rechten Koronararterie als Normvariante, die bei eventuellen Katheter-Interventionen im rechten Herzen berücksichtigt werden muss. Links EKG-gegatete Computertomographie mit Kontrastmittel, Mitte mit Segmentation (Koronarien hellrot, rechter Vorhof gelb), rechts Volumen Rendering, in der man das Eintauchen der RCA in das Herz (oben) und das Austreten basal (unten) gut erkennen kann.
Prevalence
and characteristics of coronary artery anomalies in an adult population undergoing multidetector-row computed tomography for the evaluation of coronary artery disease. Volume-rendered image show high take-off of the right coronary artery (RCA) above the sinotubular junction
Choking
sensation in chest and shortness of breath for 10 years. VR showed a coronary fistula and aneurysmal dilatation connection to the LV, as well as expansion of the ascending aortic lumen and the aortic sinus.
Prevalence
and characteristics of coronary artery anomalies in an adult population undergoing multidetector-row computed tomography for the evaluation of coronary artery disease. 3-D volume-rendered images of the coronary tree showing a single coronary artery arising from the left coronary sinus, where the left main artery (LM) gives rise to the right coronary artery (RCA) as shown by the black arrow. The RCA runs a malignant course between the pulmonary artery (PA) and the aorta
Prevalence
and characteristics of coronary artery anomalies in an adult population undergoing multidetector-row computed tomography for the evaluation of coronary artery disease. A patient with a single coronary artery. Volume-rendered and cardiac transparency images reveals a SCA arising from the left sinus of Valsalva and gives off the left anterior descending (LAD) and circumflex (LCx) branches. The right coronary artery ostium was congenitally absent (Panel A). The LCx is markedly dominant and continues beyond the crux into the atrioventricular groove and provides branches to the right ventricle and atrium (Panel B)
Prevalence
and characteristics of coronary artery anomalies in an adult population undergoing multidetector-row computed tomography for the evaluation of coronary artery disease. A patient with a single coronary artery originating from the right sinus of Valsalva. a Axial image demonstrating the left main coronary artery travelling between the aorta (AO) and the right ventricular outflow tract (b). Cardiac transparency image shows the anomalous origin of the LM, its course and the detailed anatomic relationship
Prevalence
and characteristics of coronary artery anomalies in an adult population undergoing multidetector-row computed tomography for the evaluation of coronary artery disease. Three-dimensional volume-rendered image shows the RCA arising from the left coronary sinus and with a malignant inter-arterial course between the pulmonary artery (PA) and the aorta (Ao)
Angiographic
images showing a bridge on the left anterior descending coronary artery (LAD) in a male patient of 65 years. A1) Right anterior oblique view taken at end systole. The compressed vessel segment is indicated by the two arrows. B1) Left anterior oblique view taken nearly at the same instant. A2) Same view as in A1, but taken 133 ms later. The tunneled segment is no longer compressed. B2) Same view as in B1 but 133 ms later.
Choking
sensation in chest and shortness of breath for 10 years. MIP showed a coronary fistula connected with the LV.
Congenital
coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. A patient with angina symptoms during exercise stress test revealed a rudimentary fistula from the LAD to the pulmonary artery.
Congenital
coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. A patient with a complex coronary-pulmonary artery fistula presenting with previous syncope. (a, b) Volume-rendered three-dimensional images show a big plexus of the tortuous vessels arising from the proximal left anterior descending artery. (c) Axial images of the same patient show the course of the fistula ending into a pulmonary vein.
Fistula
Between Right Coronary Artery and Left Atrium via Sinoatrial Artery: A Rare Entity. Cardiac CT angiography maximum intensity projection image shows sinoatrial artery which is a branch of right coronary artery (RCA), fistulates to the left atrium.
Fistula
Between Right Coronary Artery and Left Atrium via Sinoatrial Artery: A Rare Entity. Cardiac CT angiography volume-rendered image shows sinoatrial artery which is a branch of right coronary artery (RCA) and fistulates to the left atrium.
Split right
coronary artery in CT angiography. Coronal CT image. The anterior devision of the split right coronary artery.
Prevalence
and characteristics of coronary artery anomalies in an adult population undergoing multidetector-row computed tomography for the evaluation of coronary artery disease. Volume-rendered images show the absence of the left main coronary artery, with separate ostia of the LAD and LCX arteries from the left sinus of Valsalva (LSV). A = aorta
Prevalence
and characteristics of coronary artery anomalies in an adult population undergoing multidetector-row computed tomography for the evaluation of coronary artery disease. 3-D Volume-rendered images, shows the entire coronary system originating from right sinus of Valsalva from three separate ostia. Left anterior descending coronary artery passes anterior to the right ventricular outflow tract. Circumflex artery passes posteriorly between the left atrium and the aortic root to resume its normal position in left atrioventricular groove. The Right coronary artery has normal configuration
Prevalence
and characteristics of coronary artery anomalies in an adult population undergoing multidetector-row computed tomography for the evaluation of coronary artery disease. Three-dimensional volume-rendered image shows the dilated RCA from the aorta (Ao), the anomalous origin of the LMCA from pulmonary artery (PA), along with their anatomical relationship with surrounding structures. Rich collateral channels between RCA and LCA are shown
Anomalous
course of coronary arteries • Transseptal course of left coronary artery - Ganzer Fall bei Radiopaedia
Congenital
coronary artery anomalies • Separate origin of right coronary and conus arteries: normal variant - Ganzer Fall bei Radiopaedia
Congenital
coronary artery anomalies • Right coronary artery aneurysm - Ganzer Fall bei Radiopaedia
Anomalous
course of coronary arteries • Anomalous origin of the circumflex artery with retro-aortic course - Ganzer Fall bei Radiopaedia
Congenital
coronary artery anomalies • Single coronary artery - Ganzer Fall bei Radiopaedia
Anomalous
course of coronary arteries • Tubular origin of right coronary artery - Ganzer Fall bei Radiopaedia
Interarterial
course of the left coronary artery • Aberrant left main coronary artery (ALMCA) arising from the right sinus with interarterial course - Ganzer Fall bei Radiopaedia
Congenital
coronary artery anomalies • Double outlet right ventricle, malposition of the great vessels and pulmonary hypoplasia - treated with Rastelli procedure - Ganzer Fall bei Radiopaedia
Congenital
coronary artery anomalies • Single coronary artery - Ganzer Fall bei Radiopaedia
Congenital
coronary artery anomalies • Separate left anterior descending artery and left circumflex artery origins - Ganzer Fall bei Radiopaedia
Two rare
cases of absent coronary arteries (LCX and RCA). Volume rendered image shows a superdominant RCA in the base of the heart with an absent LCX.
Two rare
cases of absent coronary arteries (LCX and RCA). Volume rendered image shows complete absence of the RCA at the level of the right coronary ostium.
Anomalous
course of coronary arteries • Anomalous right coronary artery (ARCA) with interarterial course - Ganzer Fall bei Radiopaedia
Prevalence
and characteristics of coronary artery anomalies in an adult population undergoing multidetector-row computed tomography for the evaluation of coronary artery disease. A patient with anomalous origin of the left coronary system from the right coronary cusp (separate ostium). 3-D volume-rendered and images show the anomalous origin of the LM, its course and the detailed anatomic relationship
Congenital
coronary artery anomalies • Quadrifurcation of the left main stem - Ganzer Fall bei Radiopaedia
Congenital coronary artery anomalies (CCAAs) are not common, found only in ~1% (range 0.1-2%) of patients .
The most important finding to look for is the "malignant" course of anomalous coronary artery, i.e. does the artery run between big pulsating objects - right ventricular outflow tract / pulmonary artery on one side and aorta on the other. Increased pulsations during or following exercise can sometimes compress the coronary artery enough to diminish blood flow to the myocardium, which can cause re-entry phenomenon in the myocardium and sudden cardiac death due to ventricular fibrillation or sustained ventricular tachycardia.
Interarterial "malignant" course is most commonly identified in the right coronary artery, classically presenting in young adults or teenagers with sudden cardiac death. It is estimated that around a quarter of sudden cardiac deaths in this population is caused by malignant coronary artery course.
Intramural course of a coronary artery (known as myocardial bridging) is another lesion which may be hemodynamically significant and present with exertional angina. Usually, it occurs at mid LAD. It is important to describe the location (LAD segment relative to branch vessels), length, and depth of bridging in your report.
Of course, all anomalous coronary artery anatomy should be described in the radiology report, as this may be used to guide catheter angiography by the interventional cardiologist .
Related pathology
A vast number of different coronary artery abnormalities have been described and are discussed separately (see related articles).
Siehe auch:
- atypischer Verlauf der Koronararterien
- separater Abgang von LAD und LCX
- Bland-White-Garland-Syndrom
- intraatrialer Verlauf der RCA
- anomalous/"malignant" origin of coronary artery
- kongenitale Fistelungen Koronararterien
- anomalous left main coronary arterial origin
- Fistelungen Koronararterien
- intramyokardialer Verlauf der Koronararterien
- Fistel zwischen Koronararterie und Pulmonalarterie
- Ursprung der LCX aus RCA
- Lipton-Klassifikation
- separate origin of right coronary and conus arteries
- congenital atresia of the right coronary artery ostium
- Fistel zwischen rechter Koronararterie und linkem Vorhof
- kongenitale Stenose oder Atresie der Koronararterien
- Fistel Koronararterie zur Herzkammer
- LAD arising from the right coronary sinus
- split right coronary artery
- singuläre Koronararterie
- nicht angelegter Ramus circumflexus (LCX)
- LCx and LAD arising separately from the right coronary sinus
- hoher Abgang der Koronararterien oberhalb des sinotubulären Übergangs
- nicht angelegte rechte Koronararterie
- nicht angelegte Koronararterien
und weiter:
- Herzfehler
- coronary arteries
- Varianten der Herzanatomie
- interarterieller Verlauf der RCA
- quadricuspid aortic valve
- Sinus aortae
- linke Koronararterie
- anomalous left coronary artery off the pulmonary artery
- interarterieller Verlauf der linken Koronararterie
- Koronararterien
- CT-Koronarangiographie
- Myokardinfarkt
- Left circumflex arising from right coronary sinus
- Quadrifurkation der linken Koronararterie
Assoziationen und Differentialdiagnosen zu Normvarianten Koronararterien:
hoher Abgang
der Koronararterien oberhalb des sinotubulären Übergangs
LCx and LAD
arising separately from the right coronary sinus
Fistel
zwischen Koronararterie und Pulmonalarterie
