Coronary Artery Anomalies in Review: Anomalous Origin, Aneurysms, and Fistulae

Coronary artery anomalies are rare congenital abnormalities involving abnormal coronary artery origin and incomplete/abnormal vessel development. These anomalies encompass a broad anatomical spectrum with varied clinical presentations ranging from sudden cardiac arrest in young athletes to incidental findings in asymptomatic adults. While more data on anatomy and clinical presentation has emerged in the last decade, management remains highly individualized, guided by clinical presentation, anatomical characteristics, and patient preferences. This review provides an overview of each anomaly and recent advances in imaging, surgical planning, and risk stratification. We also highlight the challenges in optimizing management strategies, addressing gaps in evidence, and achieving consensus to refine risk stratification tools and support clinical decision-making.