Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation

Non-invasive assessment of vulnerable plaque

BACKGROUND

Sudden cardiac death or unheralded acute coronary syndromes are common initial manifestations of coronary atherosclerosis and most such events occur at sites of non-flow limiting coronary atherosclerosis.

OBJECTIVE

Non-invasive detection of high-risk plaques might provide a means to improve risk stratification in primary and secondary prevention settings.

METHODS

This review is focused on the potential of multidetector computed tomography coronary angiography (MDCT-CA) to provide the opportunity to identify different aspects of plaque vulnerability throughout the coronary tree in an accurate, fast, safe and non-invasive manner.

CONCLUSION

Coronary artery calcium scoring, on top of established risk stratification, could potentially be a cost-effective strategy for primary prevention. MDCT-CA allows a non-invasive evaluation of several features commonly seen in vulnerable plaques and has demonstrated an independent prognostic value on a patient basis. The value of the technique itself might result, potentially, in a better estimation of the relative risk of an invidual plaque to rupture.

[Anomalous origin of coronary arteries in adults]

In lack of structural congenital heart disease, anomalous origin of a coronary artery is rare with an angiographic prevalence of approximately 1%. The prognosis depending on anatomical features, initial course of coronary ectopic vessel is important to be considered. Although some anomalies are associated with sudden death, the majority are simply incidental anatomic findings. In patients with high-risk coronary anomalies, the treatment is not clearly codified. Large-scale prospective multicenter studies are needed to define recommendations in the future.

An anomalous left anterior descending artery with myocardial bridging in a patient with a true left anterior descending artery

We report the case of an anomalous left anterior descending (LAD) artery with myocardial bridging, which originated from the proximal right coronary artery in a patient with a true LAD artery.

Congenital coronary artery anomalies in adults: non-invasive assessment with multidetector CT

Congenital coronary anomalies (CCAs) are uncommon but can cause sudden cardiac death or other symptoms of myocardial ischaemia, especially in young healthy subjects. Conventional coronary angiography (CA) is an invasive and expensive procedure, and cannot provide three-dimensional data on the anomalous vessel. Electrocardiographic gated multidetector CT (MDCT) has been reported to be useful for non-invasive evaluation of CCAs. The purpose of this pictorial review is to discuss and illustrate different CCAs in terms of clinical importance, type and manifestations using MDCT. Knowledge of the CT appearances and an understanding of the clinical significance of these anomalies are essential for making the correct diagnosis and planning patient treatment.

Cardiac multi-detector CT: its unique contribution to cardiology practice

Medical practice is moving fast towards non-invasive and non-surgical disease management. While significant progress has been made with coronary artery disease prevention, MDCT stands as an ideal non-invasive tool for its progression. It accurately assesses both arterial lumen and wall disease. Although the main concern of current cardiology practice is the coronary stenotic disease, arterial wall calcification itself may significantly contribute to patients' symptoms. Thus, in addition to the beneficial use of MDCT in patients with mild to moderate risk for coronary disease, the unique information it provides on wall disease may assist the management of symptomatic patients with no flow-limiting lesions.

Coronary artery anomalies: classification and electrocardiogram-gated multidetector computed tomographic findings

Congenital coronary artery anomaly is an uncommon condition. Most of these anomalies are clinically silent without associated myocardial ischemia, but some of those may cause significant myocardial ischemia or infarction. Multidetector computed tomography with electrocardiogram (ECG)-gating has a faster volume coverage and higher spatial and temporal resolution and is a noninvasive and accurate technique that can be used to show these kinds of anomalies. Understanding the computed tomographic findings of various coronary artery anomalies is important for obtaining an accurate diagnosis and for formulating an optimal patient treatment plan.

Native whole-heart coronary imaging for the identification of anomalous origin of the coronary arteries

Congenital abnormalities of the coronary arteries are an uncommon cause of chest pain and in some cases may cause sudden cardiac death. We examined with magnetic resonance (MR) a 52 year-old woman presenting with effort angina, and positive treadmill stress test. Whole-heart coronary imaging performed without paramagnetic contrast agents revealed an anomalous origin of a single coronary artery from the right sinus of Valsalva. This is one of the first reports describing whole-heart coronary MR finding of an anomalous origin of the coronary arteries, obtained without contrast agents.

Bland-White-Garland syndrome of anomalous left coronary artery arising from the pulmonary artery (ALCAPA): a historical review

The landmark 1933 case report from Massachusetts General Hospital by Bland, White and Garland (Am Heart J 8:787-801) described a 3-month-old child with progressive feeding problems, cardiomegaly on chest radiography, and EKG evidence of left ventricular damage. Of interest was the fact that the vigilant father of the infant was Aubrey Hampton, a radiologist and future chairman of radiology at Massachusetts General Hospital. At autopsy, the left coronary artery originated from the pulmonary artery rather than from the aorta. Effective treatment for this condition was not available until 1960 when Sabiston, Neill and Taussig showed that the blood flowed from the left coronary artery toward the pulmonary artery. The anomalous left coronary artery was ligated at its junction with the pulmonary artery and the child survived. This historical review of Bland-White-Garland syndrome, now known as anomalous left coronary artery arising from the pulmonary artery (ALCAPA), stresses the continued diagnostic significance of cardiomegaly on chest radiography and EKG changes suggesting left ventricular damage in 2- to 3-month-old infants with feeding intolerance or irritability. With a high index of suspicion, an echocardiogram can be obtained to confirm the diagnosis. Modern surgical methods involve left coronary artery translocation and afford excellent outcomes.

Normal and variant coronary arterial and venous anatomy on high-resolution CT angiography

OBJECTIVE

This article displays the normal and variant anatomy of the coronary arteries and subjacent cardiac veins using a high-resolution 64-MDCT scanner.

CONCLUSION

Knowledge of the anatomy of the coronary arteries and subjacent cardiac veins as displayed with maximum intensity and volume-rendered projections is important for correct image interpretation of coronary CT angiography examinations.

MDCT coronary angiography for diagnosis of anomalous origin right coronary artery: a case report

This is a case report of anomalous origin of the right coronary artery, which arises from the left sinus of Valsalva depicted with multi-detector row tomography (MDCT) coronary angiography performed in emergency. In symptomatic patient, this anomalous origin is considered a malignant anomaly and needs urgent surgical treatment. Some studies demonstrated that MDCT is a reliable non-invasive technique to identify and define anomalous coronary arteries (ACAs) and their course.

CT and MRI of coronary artery disease: evidence-based review

OBJECTIVE

The educational objective of this evidence-based self-assessment module is to use case examples to review the current evidence and the roles of CT and MRI in evaluating and managing patients with both congenital and acquired coronary artery disease.

CONCLUSION

In this educational module, we review the use of CT and MRI in the noninvasive diagnosis and management of patients with coronary artery disease.

Detection of a double right coronary artery with 16-row multidetector computed tomography

We present the case of a 46-year-old male patient with known history of coronary artery disease and recurrent episodes of angina pectoris. Coronary angiography revealed two vessels originating from the right coronary sinus. However, a clear distinction between a double RCA and a high take off of a large right ventricular branch could not be made. Contrast-enhanced MDCT was performed on a 16-row scanner which clearly depicted cardiac anatomy and finally established the diagnosis of a double RCA. To our knowledge, this is the first report of a true double RCA diagnosed by MDCT.