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Coronary Artery Anomalies: Angiographic Recognition of High Risk

Case Presentation. 43-year-old male with longstanding history of palpitationsUndergoes cardiac CT scan which reveals abnormal coronary calcium score and suspected abnormal origin of left coronaryReferred for diagnostic catheterization (echo also performed). Coronary Artery Anomalies. Pete Maravich(June 22, 1947

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Coronary Artery Anomalies: Angiographic Recognition of High Risk

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    1. Coronary Artery Anomalies: Angiographic Recognition of High Risk Richard E. Browne, MD John D. Symanski, MD

    2. Case Presentation 43-year-old male with longstanding history of palpitations Undergoes cardiac CT scan which reveals abnormal coronary calcium score and suspected abnormal origin of left coronary Referred for diagnostic catheterization (echo also performed)

    10. Coronary Artery Anomalies

    12. Coronary Artery Anomalies Demonstrated by Echocardiography

    17. Autopsy: ~30%, Angiographically: <5% Prevalent in HCM patients Segment proximal to bridge frequently shows atherosclerotic plaque (tunnel spared) Symptomatic patients may be treated with ß-blocker or CCB Myotomy, CABG, and stenting in refractory cases Myocardial Bridging Tunneled LAD

    20. High Takeoff Coronary Ostia Above Sinuses of Valsalva

    21. LAD and CFX Arising from Separate Ostia

    22. Retro-Aortic Left Circumflex

    23. Retro-Aortic Left Circumflex

    24. Absent Circumflex Super-dominant RCA

    25. Absent Right Coronary Super-dominant Circumflex

    26. Left Coronary Arising From PA Bland-White-Garland Syndrome

    28. Anomalous RCA Takeoff From Left Coronary Sinus

    29. Anterior Course of RCA Arising From Left Coronary Sinus

    30. Anomalous Right Coronary Artery RCA Arising From Left Coronary Sinus

    31. Coronary Artery Anomalies Magnetic Resonance Imaging

    32. Left Main Arising from Right Coronary Sinus Subtypes: Anterior free-wall course Retro-aortic course Septal course Inter-arterial- incidence 1:12,500 [Accounts for 60% of anomalous left main from right coronary sinus (2.8% overall coronary anomalies). Recognized association with ischemic symptoms and sudden death >50%]

    33. Left Main from Right Sinus Anterior Course

    34. Left Main from Right Sinus Anterior Course

    35. Anomalous Left Coronaries Retro-Aortic Circumflex, Anterior LAD

    36. Anomalous Left Main Retro-Aortic

    37. Retro-Aortic Course of Left Main

    38. Anomalous Left Main Inter-Arterial

    39. Inter-arterial Course of Left Main Arising From Right Coronary Sinus

    40. Anomalous Coronary Artery 15-year-old male soccer player Syncope one year prevously (ECG normal). Died suddenly while running Acute angle take-off of LMCA from right coronary sinus

    42. Left Main from Right Sinus Septal Course

    43. Left Main from Right Sinus Septal Course

    44. Anomalous Left Main Angiographic Features of Subtypes

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