Table 1
Summary of prevalence, evaluation methods, and treatment for anomalous coronary arteries. R-AAOCA: right anomalous aortic origin of coronary artery; L-AAOCA: left anomalous aortic origin of coronary artery: ARCAPA: anomalous right coronary artery from the pulmonary artery; ALCAPA: anomalous left coronary artery from the pulmonary artery; CAF: coronary artery fistula; CCTA: coronary computed tomography angiography; CABG: coronary artery bypass graft; PCI: percutaneous coronary intervention
| ANOMALY | PREVALENCE (PER 100,000) | REPAIR INDICATED? | IDEAL IMAGING MODALITY | SIGNIFICANT FEATURES TO EVALUATE | TREATMENT OPTIONS |
|---|---|---|---|---|---|
| R-AAOCA | 0.33% (330)3 | Symptoms or ischemia | CCTA | Interarterial course, intramural segment, slit-like ostium, AAOCA dominance | Unroofing, reimplantation |
| L-AAOCA | 0.12% (120)3 | Symptoms or ischemia | |||
| ARCAPA | 0.002% (2)22 | Yes | Collaterals, dominance | Reimplantation, ligation, CABG, channel surgery | |
| ALCAPA | 0.008% (8)22 | Yes | |||
| CAF | 0.002% (2)33 | Symptoms | Fistula course, size, collaterals | Percutaneous intervention, surgical ligation +/- bypass | |
| Aneurysm | 0.3-5.3% (300-5,300)48,49 | Symptoms | Calcification, luminal diameter, thrombi and aneurysmal features | PCI, CABG +/- ligation |
Figure 1
A 33-year-old man with R-AAOCA diagnosed as an adult. (A) CCTA shows the anomalous origin of the dominant RCA from the left aortic sinus of Valsalva, (B) with slit-like ostium and intramural course. R-AAOCA: right anomalous origin of the left coronary artery; CCTA: coronary computed tomogram angiography; RCA: right coronary artery
Figure 2
A 26-year-old woman with ALCAPA diagnosed as an adult. (A) Preoperative coronary angiogram shows a large RCA with septal and epicardial collaterals to the LAD and LCX that converge into LMCA draining into the PA. (B) Preoperative transthoracic echocardiography with color Doppler reveals collateral vessels in the interventricular septum. (C1,2) Pre- and postoperative CCTA demonstrate the abnormal origin of LM from the PA and postsurgical SVG graft placement, respectively. ALCAPA: anomalous left coronary artery from the pulmonary artery; RCA: right coronary artery; LAD: left anterior descending artery; LCX: left circumflex artery; LMCA: left main coronary artery; PA: pulmonary artery; cCTA: coronary computed tomogram angiography; SVG: saphenous vein graft