Congenital coronary artery anomalies

Dr James Harvey and Radswiki et al.

Congenital coronary artery anomalies (CCAAs) are not common, found only in ~1% (range 0.1-2%) of patients 1,3.

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 7.

Related pathology

A vast number of different coronary artery abnormalities have been described and are discussed separately (see related articles). 

Congenital coronary artery anomalies
Anatomy: Thoracic
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Article information

rID: 12296
System: Vascular, Cardiac
Section: Anatomy
Synonyms or Alternate Spellings:
  • Congenital coronary artery anomaly
  • Congenital coronary arterial anomalies
  • Congenital coronary artery anomalies (CCAA)
  • CCAA
  • Congenital coronary artery abnormality
  • Congenital coronary artery abnormalities
  • Congenital coronary arterial abnormalities
  • Coronary artery anomalies (CAAs)
  • Coronary artery anomalies
  • Coronary artery anomaly
  • Congenital anomaly of the coronary arteries
  • Coronary artery variants
  • Coronary artery variant

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Cases and figures

  • Case 1: anomalous right coronary artery
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  • Case 2: atypical origin and course of the left coronary
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  • Case 2: atypical origin and course of the left coronary
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  • Case 3: separate origin of RCA and conus artery
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  • Case 4: RCA aneurysm
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  • Case 5: anomalous course of circumflex artery
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  • Case 6: single coronary artery
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  • Case 7: separate origins of the LCx and LAD
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  • Case 8: anomalous RCA ostium at ST junction
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  • Case 9: ALMCA with inter-arterial malignant course
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