Anomalous coronary arteries: What we know and what we do not know

Excerpt

Clinically recognized coronary anomalies in adults are uncommon. Contemporary imaging studies have demonstrated a prevalence of 1.3% in the largest direct angiographic series (n = 126,595), from 1960 to 1988 at the Cleveland Clinic,1 2.33% in a recent consecutive CT coronary angiographic series of 2572 patients from Greece,2 and 0.3% in 59,844 cardiac magnetic resonance scans from England.3 Furthermore, not all of the anomalies identified in those studies were of clinical relevance to the patients. Some, such as a high takeoff of a coronary (at or above the sinotubular junction) without an intramural course, an anomalous circumflex coronary originating from the right coronary sinus and coursing posterior to the aorta and separate origins of the circumflex and left anterior descending (LAD) coronary arteries from the left sinus of Valsalva, are typically of no clinical consequence to the patient, although they may be of technical interest to an angiographer. In the aforementioned CT series, those typically benign anomalies represented 41 of the 60 total cases identified. …