Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Coronary Artery Anomaly, What Radiologist Should Know?

영상의학과 의사가 꼭 알아야 할 관상동맥기형

  • Hyun Jin Lee (Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine) ;
  • Jin Young Kim (Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine)
  • 이현진 (계명대학교 의과대학 계명대학교 동산병원 영상의학과) ;
  • 김진영 (계명대학교 의과대학 계명대학교 동산병원 영상의학과)
  • Received : 2021.10.23
  • Accepted : 2021.12.24
  • Published : 2022.01.01
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Abstract

Cardiac CT is the most accurate tool for diagnosing and evaluating coronary artery anomalies. Coronary anomalies can often be observed as the number of cardiac CT scans increases. In this review article, we described the CT findings and clinical significance of coronary anomalies that radiologists should know. In particular, we described the dangerous anatomical findings of coronary anomalies on CT images in detail.

심장 전산화단층촬영(이하 CT)은 현재 관상동맥기형을 진단하고, 평가하는 가장 정확한 진단 도구로 자리매김하였으며, 심장 CT 촬영 건수가 증가함에 따라 관상동맥기형을 종종 관찰할 수 있다. 본 종설은 관상동맥기형에서 영상의학과 의사들이 꼭 알아야 할 대표적인 기형의 CT 소견들에 대해 다루었다. 관상동맥기형의 종류를 3부분 즉, 기시부, 동맥 내, 그리고 연결 부위로 나누어 설명하였으며, 임상에서 볼 수 있는 대표적인 기형들 중심으로 다루었다. 특히 혈역학적 이상을 유발하거나, 급사의 위험이 있는 기형들의 CT상 위험한 해부학적 소견에 대해서는 자세히 기술하였다.

Keywords

Acknowledgement

The authors thank Professor Jongmin Lee, Department of Radiology, Kyungpook National University Hospital, for providing Fig. 9 (ALCAPA case).

References

  1. Yildiz A, Okcun B, Peker T, Arslan C, Olcay A, Bulent Vatan M. Prevalence of coronary artery anomalies in 12,457 adult patients who underwent coronary angiography. Clin Cardiol 2010;33:E60-E64 https://doi.org/10.1002/clc.20588
  2. Safak O, Gursul E, Yesil M, Tuluce SY, Arikan ME, Ozyildirim S, et al. Prevalence of coronary artery anomalies in patients undergoing coronary artery angiography: a review of 16768 patients. A retrospective, single-center study. Minerva Cardioangiol 2015;63:113-120
  3. Cheezum MK, Ghoshhajra B, Bittencourt MS, Hulten EA, Bhatt A, Mousavi N, et al. Anomalous origin of the coronary artery arising from the opposite sinus: prevalence and outcomes in patients undergoing coronary CTA. Eur Heart J Cardiovasc Imaging 2016;18:224-235 https://doi.org/10.1093/ehjci/jev323
  4. Angelini P. Coronary artery anomalies: an entity in search of an identity. Circulation 2007;115:1296-1305 https://doi.org/10.1161/CIRCULATIONAHA.106.618082
  5. Gentile F, Castiglione V, De Caterina R. Coronary artery anomalies. Circulation 2021;144:983-996 https://doi.org/10.1161/CIRCULATIONAHA.121.055347
  6. Kim YJ, Yong HS, Kim SM, Kim JA, Yang DH, Hong YJ; Korean Society of Radiology; Korean Society of Cardiology. Korean guidelines for the appropriate use of cardiac CT. Korean J Radiol 2015;16:251-285 https://doi.org/10.3348/kjr.2015.16.2.251
  7. Kini S, Bis KG, Weaver L. Normal and variant coronary arterial and venous anatomy on high-resolution CT angiography. AJR Am J Roentgenol 2007;188:1665-1674 https://doi.org/10.2214/AJR.06.1295
  8. Harky A, Noshirwani A, Karadakhy O, Ang J. Comprehensive literature review of anomalies of the coronary arteries. J Card Surg 2019;34:1328-1343 https://doi.org/10.1111/jocs.14228
  9. Kim SY, Seo JB, Do KH, Heo JN, Lee JS, Song JW, et al. Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation. Radiographics 2006;26:317-333; discussion 333-334 https://doi.org/10.1148/rg.262055068
  10. Ko,sar P, Ergun E, Ozturk C, Ko,sar U. Anatomic variations and anomalies of the coronary arteries: 64-slice CT angiographic appearance. Diagn Interv Radiol 2009;15:275-283
  11. O'Brien JP, Srichai MB, Hecht EM, Kim DC, Jacobs JE. Anatomy of the heart at multidetector CT: what the radiologist needs to know. Radiographics 2007;27:1569-1582 https://doi.org/10.1148/rg.276065747
  12. Hostiuc S, Negoi I, Rusu MC, Hostiuc M. Myocardial bridging: a meta-analysis of prevalence. J Forensic Sci 2018;63:1176-1185 https://doi.org/10.1111/1556-4029.13665
  13. Lee MS, Chen CH. Myocardial bridging: an up-to-date review. J Invasive Cardiol 2015;27:521-528
  14. Tarantini G, Migliore F, Cademartiri F, Fraccaro C, Iliceto S. Left anterior descending artery myocardial bridging: a clinical approach. J Am Coll Cardiol 2016;68:2887-2899 https://doi.org/10.1016/j.jacc.2016.09.973
  15. Graidis C, Dimitriadis D, Karasavvidis V, Dimitriadis G, Argyropoulou E, Economou F, et al. Prevalence and characteristics of coronary artery anomalies in an adult population undergoing multidetector-row computed tomography for the evaluation of coronary artery disease. BMC Cardiovasc Disord 2015;15:112
  16. Loukas M, Andall RG, Khan AZ, Patel K, Muresian H, Spicer DE, et al. The clinical anatomy of high take-off coronary arteries. Clin Anat 2016;29:408-419 https://doi.org/10.1002/ca.22664
  17. Tsai WL, Wei HJ, Tsai IC. High-take-off coronary artery: a haemodynamically minor, but surgically important coronary anomaly. Pediatr Radiol 2010;40:232-233 https://doi.org/10.1007/s00247-009-1413-4
  18. Ogden JA. Congenital anomalies of the coronary arteries. Am J Cardiol 1970;25:474-479 https://doi.org/10.1016/0002-9149(70)90016-0
  19. Dodge-Khatami A, Mavroudis C, Backer CL. Congenital heart surgery nomenclature and database project: anomalies of the coronary arteries. Ann Thorac Surg 2000;69:S270-S297 https://doi.org/10.1016/S0003-4975(99)01248-5
  20. Yilmaz-Cankaya B, Kantarci M, Yalcin A, Durur-Karakaya A, Yuce I. Absence of the left main coronary artery: MDCT coronary angiographic imaging. Eurasian J Med 2009;41:56-58
  21. Topaz O, DiSciascio G, Cowley MJ, Soffer A, Lanter P, Goudreau E, et al. Absent left main coronary artery: angiographic findings in 83 patients with separate ostia of the left anterior descending and circumflex arteries at the left aortic sinus. Am Heart J 1991;122:447-452 https://doi.org/10.1016/0002-8703(91)90998-W
  22. Cheezum MK, Liberthson RR, Shah NR, Villines TC, O'Gara PT, Landzberg MJ, et al. Anomalous aortic origin of a coronary artery from the inappropriate sinus of Valsalva. J Am Coll Cardiol 2017;69:1592-1608 https://doi.org/10.1016/j.jacc.2017.01.031
  23. Lee HJ, Hong YJ, Kim HY, Lee J, Hur J, Choi BW, et al. Anomalous origin of the right coronary artery from the left coronary sinus with an interarterial course: subtypes and clinical importance. Radiology 2012;262:101-108 https://doi.org/10.1148/radiol.11110823
  24. Brothers JA, Whitehead KK, Keller MS, Fogel MA, Paridon SM, Weinberg PM, et al. Cardiac MRI and CT: differentiation of normal ostium and intraseptal course from slitlike ostium and interarterial course in anomalous left coronary artery in children. AJR Am J Roentgenol 2014;204:W104-W109 https://doi.org/10.2214/AJR.14.12953
  25. Kim JY, Hong YJ, Han K, Lee S, Kim YJ, Choi BW, et al. Evaluation of the ostium in anomalous origin of the right coronary artery with an interarterial course using dynamic cardiac CT and implications of ostial findings. Korean J Radiol 2022 Jan [Epub]. https://doi.org/10.3348/kjr.2021.0270
  26. Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardio 2019;73:e81-e192 https://doi.org/10.1016/j.jacc.2018.08.1029
  27. Grani C, Benz DC, Schmied C, Vontobel J, Mikulicic F, Possner M, et al. Hybrid CCTA/SPECT myocardial perfusion imaging findings in patients with anomalous origin of coronary arteries from the opposite sinus and suspected concomitant coronary artery disease. J Nucl Cardiol 2017;24:226-234 https://doi.org/10.1007/s12350-015-0342-x
  28. Del Torto A, Baggiano A, Guglielmo M, Muscogiuri G, Pontone G. Anomalous origin of the left circumflex artery from the right coronary sinus with retro-aortic course: a potential malign variant. J Cardiovasc Comput Tomogr 2020;14:e54-e55 https://doi.org/10.1016/j.jcct.2019.01.021
  29. Pena E, Nguyen ET, Merchant N, Dennie C. ALCAPA syndrome: not just a pediatric disease. Radiographics 2009;29:553-565 https://doi.org/10.1148/rg.292085059
  30. Boutsikou M, Shore D, Li W, Rubens M, Pijuan A, Gatzoulis MA, et al. Anomalous left coronary artery from the pulmonary artery (ALCAPA) diagnosed in adulthood: varied clinical presentation, therapeutic approach and outcome. Int J Cardiol 2018;261:49-53 https://doi.org/10.1016/j.ijcard.2018.02.082
  31. Al Umairi RS, Al Kindi F, Al Busaidi F. Anomalous origin of the left coronary artery from the pulmonary artery: the role of multislice computed tomography (MSCT). Oman Med J 2016;31:387-389 https://doi.org/10.5001/omj.2016.77
  32. Goo HW. Anomalous origin of the coronary artery from the pulmonary artery in children and adults: a pictorial review of cardiac imaging findings. Korean J Radiol 2021;22:1441-1450 https://doi.org/10.3348/kjr.2021.0034
  33. Al Umairi R, Al-Khouri M. Prevalence, spectrum, and outcomes of single coronary artery detected on coronary computed tomography angiography (CCTA). Radiol Res Pract 2019;2019:2940148
  34. Desmet W, Vanhaecke J, Vrolix M, Van de Werf F, Piessens J, Willems J, et al. Isolated single coronary artery: a review of 50000 consecutive coronary angiographies. Eur Heart J 1992;13:1637-1640 https://doi.org/10.1093/oxfordjournals.eurheartj.a060117
  35. Lipton MJ, Barry WH, Obrez I, Silverman JF, Wexler L. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance. Radiology 1979;130:39-47 https://doi.org/10.1148/130.1.39
  36. Turkmen S, Yolcu M, Sertcelik A, Ipek E, Dokumaci B, Batyraliev T. Single coronary artery incidence in 215140 patients undergoing coronary angiography. Folia Morphol (Warsz) 2014;73:469-474 https://doi.org/10.5603/FM.2014.0070
  37. de la Cruz MV, Cayre R, Angelini P, Noriega-Ramos N, Sadowinski S. Coronary arteries in truncus arteriosus. Am J Cardiol 1990;66:1482-1486 https://doi.org/10.1016/0002-9149(90)90539-D
  38. Sharbaugh AH, White RS. Single coronary artery. Analysis of the anatomic variation, clinical importance, and report of five cases. JAMA 1974;230:243-246 https://doi.org/10.1001/jama.1974.03240020033019
  39. Elbadawi A, Baig B, Elgendy IY, Alotaki E, Mohamed AH, Barssoum K, et al. Single coronary artery anomaly: a case report and review of literature. Cardiol Ther 2018;7:119-123 https://doi.org/10.1007/s40119-018-0103-4
  40. Bozlar U, Ugurel M,S, SarI S, Akgun V, Ors F, Ta,sar M. Prevalence of dual left anterior descending artery variations in CT angiography. Diagn Interv Radiol 2015;21:34-41 https://doi.org/10.5152/dir.2014.14275
  41. Al-Umairi RS, Al-Kindi FA, Al-Tai SA. A new variant of dual left anterior descending artery anomaly: type XI. Sultan Qaboos Univ Med J 2018;18:e386-e388 https://doi.org/10.18295/squmj.2018.18.03.021
  42. Celik T, Bozlar U, Ozturk C, Balta S, Verim S, Demir M, et al. A new anomaly of the left anterior descending artery: type X dual LAD. Indian Heart J 2015;67 Suppl 3:S14-S17 https://doi.org/10.1016/j.ihj.2015.09.004
  43. Co,sansu K, TarIk Ag˘ac M, KIlIc H, Akdemir R, Gunduz H. Twin circumflex arteries: a rare coronary artery anomaly. J Tehran Heart Cent 2018;13:32-34
  44. Khan Z, Munde K, Shaikh S, Bansal N. Twin circumflex arteries: a rare coronary artery anomaly. Heart and Vascular Medicine 2019;1:2
  45. Manjunath SBN, Alex AG, Varghese L, George OK. Bilateral origin of a split circumflex coronary artery. BMJ Case Rep 2020;13:e237651
  46. Balpande NN, Singh S, Bodhey N. Accessory left circumflex arising from left coronary sinus. Ann Cardiol Cardiovasc Med 2020;4:1039
  47. Chung J, Kim HL, Lim WH, Seo JB, Zo JH, Kim MA, et al. Double right coronary arteries originated from separate ostia with total occlusive lesion in one of the two right coronary arteries. J Lipid Atheroscler 2017;6:97-101 https://doi.org/10.12997/jla.2017.6.2.97
  48. Kim JE, Kim KH, Cho JY, Ahn YK, Jeong MH, Cho JG, et al. Myocardial infarction associated with anomalous origin of the left coronary artery from the pulmonary artery and double right coronary artery. Korean J Med 2019;94:215-220 https://doi.org/10.3904/kjm.2019.94.2.215
  49. Abolbashari M, Kar S, Marmol-Velez A, Ramos-Duran L, Mullins C, Mukherjee D, et al. Double right coronary artery and its clinical significance: review of the literature. Cardiovasc Revasc Med 2017;18:632-635 https://doi.org/10.1016/j.carrev.2017.06.016
  50. Donisan T, Sayed L. Dual ostia right coronary artery: a newly described coronary anomaly. JACC Cardiovasc Interv 2021;14:e69-e70 https://doi.org/10.1016/j.jcin.2020.12.032
  51. Yun G, Nam TH, Chun EJ. Coronary artery fistulas: pathophysiology, imaging findings, and management. Radiographics 2018;38:688-703 https://doi.org/10.1148/rg.2018170158
  52. Lim JJ, Jung JI, Lee BY, Lee HG. Prevalence and types of coronary artery fistulas detected with coronary CT angiography. AJR Am J Roentgenol 2014;203:W237-W243 https://doi.org/10.2214/AJR.13.11613
  53. Boyle S, Jesuthasan LSB, Jenkins C, Challa P, Ranjan S, Dahiya A. Coronary-cameral fistula. Circ Cardiovasc Imaging 2019;12:e008691
  54. Stierle U, Giannitsis E, Sheikhzadeh A, Potratz J. Myocardial ischemia in generalized coronary artery-left ventricular microfistulae. Int J Cardiol 1998;63:47-52 https://doi.org/10.1016/S0167-5273(97)00280-5
  55. Kim H, Beck KS, Choe YH, Jung JI. Coronary-to-pulmonary artery fistula in adults: natural history and management strategies. Korean J Radiol 2019;20:1491-1497 https://doi.org/10.3348/kjr.2019.0331
  56. Kim MS, Jung JI, Chun HJ. Coronary to pulmonary artery fistula: morphologic features at multidetector CT. Int J Cardiovasc Imaging 2010;26:273-280 https://doi.org/10.1007/s10554-010-9711-3
  57. Verdini D, Vargas D, Kuo A, Ghoshhajra B, Kim P, Murillo H, et al. Coronary-pulmonary artery fistulas: a systematic review. J Thorac Imaging 2016;31:380-390 https://doi.org/10.1097/RTI.0000000000000232