Analysis of coronary artery anomalies in adults: morphology, atherosclerosis, and cardiovascular risks

Year 2024, Volume: 5 Issue: 6, 320 - 326, 23.12.2024

Serpil Çilingiroğlu Anlı , Ramazan Atak

Abstract

Aims: Despite their rarity, coronary artery anomalies (CAAs) warrant careful consideration during percutaneous or surgical interventions due to their potential influence on clinical outcomes. The objective of this study was to ascertain the prevalence and characteristics of CAAs in adult patients undergoing coronary angiography.
Methods: A retrospective analysis was conducted on 12.457 coronary angiography records from a tertiary hospital, encompassing the period from May 2007 to October 2010. The classification of anomalies adhered to the system proposed by Dr. Angelini and approved by the Congenital Heart Surgery Committee. Statistical comparisons were performed through the application of Student’s t-test, Pearson’s chi-square test, and Fisher’s exact test.
Results: An analysis of angiographies identified CAAs in 134 cases, consisting of 89 males and 45 females, with an age range spanning from 21 to 87 years . Myocardial bridging was identified in 62 instances (0.49%), coronary artery exit anomalies in 17 instances (0.14%), coronary artery aneurysms in 30 instances (0.24%), coronary artery fistula in 18 instances (0.14%) , and coronary artery atresia in one instance (0.01%). There were no substantial gender variations observed among the different types of anomalies.
Conclusion: The findings of this study align closely with previous research concerning the prevalence and characteristics of CAAs. Prompt diagnosis and angiographic assessment of congenital CAAs are essential for optimal management and minimizing procedural risks. Anatomical knowledge is indispensable in elucidating pathophysiological mechanisms, optimizing surgical strategies, and advancing diagnostic imaging techniques.

Keywords

Coronary angiography, coronary artery anomalies, myocardial bridging, sudden death, congenital anomalies

Yetişkinlerde koroner arter anomalilerinin analizi: morfoloji, ateroskleroz ve kardiyovasküler riskler

Abstract

Amaç: Konjenital koroner arter anomalileri, perkütan veya cerrahi girişimlerde oldukça önemlidir. Yetişkin popülasyonda nadir görülen koroner arter anomalileri, anjiyografi, cerrahi müdahale ve otopsi sırasında tespit edilmektedir. Bu çalışmanın amacı, koroner anjiyografi uygulanan yetişkinlerde konjenital koroner arter anomalilerinin insidansını belirlemektir.
Yöntemler: Lokman Hekim Akay Hastanesi'nde Mayıs 2007 ile Ekim 2010 tarihleri arasında gerçekleştirilen tüm koroner anjiyografi kayıtları incelendi. Koroner arter anomalileri, Dr. Angelini tarafından önerilen sınıflamaya göre değerlendirildi.
Bulgular: Bu çalışmada toplamda 12.457 koroner anjiyografi kaydı incelendi. Koroner arter anomalileri, yaşları 19 ile 97 arasında değişen 134 (%0,93) kişide (89 erkek, 45 kadın) tespit edildi. Miyokardiyal köprüler 62 (%0,49) olguda, koroner arter çıkış anomalileri 22 (%0,1) olguda, koroner arter anevrizmaları 31 (%0,2) olguda, koroner arter fistülleri 18 (%0,1) olguda ve koroner arter atreziyası ise 1 olguda saptandı.
Sonuç: Bu seride elde edilen sonuçlar, önceki çalışmalarla yüksek oranda tutarlılık göstermiştir. Koroner arter anomalilerinin cerrahi operasyonlardan önce anjiyografik olarak tespit edilmesi ve gerektiğinde anomali tipine göre yeniden düzenlenmesi önemli olduğu düşünülmektedir.

Keywords

Koroner arter anomalileri, koroner arter anjiografisi, ani ölüm

References

• Nişancı OS, Anatomi, Yıldız R (Ed.), bakım ve rehabilitasyon giriş (ss. 0-50). Konya, Eğitim Yayınevi, 2022.
• Tuo G, Marasini M, Brunelli C, Zannini L, Balbi M. Incidence and clinical relevance of primary congenital anomalies of the coronary arteries in children and adults. Cardiol Young. 2013;23(3):381-386. doi:10.1017/S1047951112000959
• Tacar O, Karadede A. Anomaly of the left anterior descending coronary artery arising from the right sinus of valsalva and ventricular septal defect in adult: a rare case. Yonsei Med J. 2005;46(5):729-732. doi:10.3349/ymj. 2005.46.5.729
• Kim SY, Seo JB, Do KH, et al. Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation. Radiographics. 2006;26(2):317-333. doi:10.1148/rg.262055068
• Zhou L, Sheng-Yu L, Dong-Bao L, Chen H. A case of myocardial infarction due to myocardial bridging alone. Clin Med (Lond). 2020;20(3):304-307. doi:10.7861/clinmed.2019-0460
• Ciliberti G, Laborante R, Di Francesco M, et al. Comprehensive functional and anatomic assessment of myocardial bridging: unlocking the gordian knot. Front Cardiovasc Med. 2022;9:970422. doi:10.3389/fcvm.2022.970422
• Van der Merwe J, Casselman F. Circumflex coronary artery ınjury during modern mitral valve surgery-a review of current concepts and perspectives. Medicina (Kaunas). 2023;59(8):1470. doi:10.3390/medicina59081470
• Rizzo S, De Gaspari M, Frescura C, Padalino M, Thiene G, Basso C. Sudden death and coronary artery anomalies. Front Cardiovasc Med. 2021;8: 636589. doi:10.3389/fcvm.2021
• Angelini P, Velasco JA, Flamm S. Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation. 2002;105(20):2449-2454. doi:10.1161/01.cir.0000016175.49835.57
• Pérez-Pomares JM, de la Pompa JL, Franco D, et al. Congenital coronary artery anomalies: a bridge from embryology to anatomy and pathophysiology--a position statement of the development, anatomy, and pathology ESC working group. Cardiovasc Res. 2016;109(2):204-216.
• Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn. 1990;21(1): 28-40. doi:10.1002/ccd.1810210110
• Kardos A, Babai L, Rudas L, et al. Epidemiology of congenital coronary artery anomalies: a coronary arteriography study on a central European population. Cathet Cardiovasc Diagn. 1997;42(3):270-275. doi:10.1002/(sici)1097-0304(199711)42:3<270::aid-ccd8>3.0.co;2-9
• Aydinlar A, Ciçek D, Sentürk T, et al. Primary congenital anomalies of the coronary arteries: a coronary arteriographic study in Western Turkey. Int Heart J. 2005;46(1):97-103. doi:10.1536/ihj.46.97
• Tuncer C, Eryonucu B, Batyraliev T, et al. Angiographic characteristics of coronary artery fistulas. Turk Kardiyol Dern Ars. 2014;42(5):456-460. doi: 10.5543/tkda.2014.66281
• Hajar R. Risk factors for coronary artery disease: historical perspectives. Heart Views. 2017;18(3):109-114. doi:10.4103/HEARTVIEWS.HEARTVIEWS_ 106_17
• Bigler MR, Ashraf A, Seiler C, et al. Hemodynamic relevance of anomalous coronary arteries originating from the opposite sinus of valsalva-ın search of the evidence. Front Cardiovasc Med. 2021;7:591326. doi:10.3389/fcvm. 2020.591326
• Yousif N, Shahin M, Lüscher TF, Obeid S. Gender differences in types, frequency, clinical manifestations and atherosclerotic burden of coronary artery anomalies. Rev Recent Clin Trials. 2019;14(1):41-46. doi:10.2174/1574887113666180820111341
• Kashyap JR, Kumar S, Reddy S, et al. Prevalence and pattern of congenital coronary artery anomalies in patients undergoing coronary angiography at a Tertiary Care Hospital of Northern India. Cureus. 2021;13(4):e14399. doi: 10.7759/cureus.14399
• Del Torto A, Baggiano A, Guglielmo M, Muscogiuri G, Pontone G. Anomalous origin of the left circumflex artery from the right coronary sinus with retro-aortic course: a potential malign variant. J Cardiovasc Comput Tomogr. 2020;14(5):e54-e55. doi:10.1016/j.jcct.2019.01.021
• Balaguer-Malfagón JR, Estornell-Erill J, Vilar-Herrero JV, Pomar-Domingo F, Federico-Zaragoza P, Payá-Serrano R. Arteria coronaria izquierda anómala en el seno de Valsalva derecho asociada a ateromatosis coronaria [Anomalous left coronary artery from the right sinus of Valsalva associated with coronary atheromatosis]. Rev Esp Cardiol. 2005;58(11):1351-1354.
• Bishnoi RN, McMillan KN, Thompson WR. Unusual sudden cardiac death from an anomalous left coronary artery from the right sinus of Valsalva. Cardiol Young. 2014;24(4):732-734. doi:10.1017/S1047951113001005
• Catanzaro JN, Makaryus AN, Catanese C. Sudden cardiac death associated with an extremely rare coronary anomaly of the left and right coronary arteries arising exclusively from the posterior (noncoronary) sinus of valsalva. Clin Cardiol. 2005;28(11):542-544. doi:10.1002/clc.4960281111
• Bruls S, Durieux R, Gach O, Lancellotti P, Defraigne JO. Sudden cardiac death revealed by an anomalous origin of the right coronary artery from the left sinus of Valsalva. Ann Thorac Surg. 2020;110(4):e315-e317. doi:10. 1016/j.athoracsur.2020.02.034
• Wu B, Kheiwa A, Swamy P, et al. Clinical significance of coronary arterial dominance: a review of the literature. J Am Heart Assoc. 2024;13(9):e032851. doi:10.1161/JAHA.123.032851
• Cheezum MK, Liberthson RR, Shah NR, et al. Anomalous aortic origin of a coronary artery from the ınappropriate sinus of Valsalva. J Am Coll Cardiol. 2017;69(12):1592-1608. doi:10.1016/j.jacc.2017.01.031
• Lv X, Li J, Liu C, et al. Single coronary ostium with obstructive hypertrophic cardiomyopathy treated using the Morrow procedure: a case report. J Cardiothorac Surg. 2022;17(1):340. doi:10.1186/s13019-022-02084-2
• Zukić F, Miljko M, Vegar-Zubović S, Behmen A, Arapović AK. Prevalence of coronary artery anomalies detected by coronary CT angiography in Canton Sarajevo, Bosnia and Herzegovina. Psychiatr Danub. 2017;29(4):830-834.
• Srinivasan KG, Gaikwad A, Kannan BR, Ritesh K, Ushanandini KP. Congenital coronary artery anomalies: diagnosis with 64 slice multidetector row computed tomography coronary angiography: a single-centre study. J Med Imaging Radiat Oncol. 2008;52(2):148-154.
• Lloyd-Jones D, Adams RJ, Brown TM, et al. American Heart Association statistics committee and stroke statistics subcommittee. Heart disease and stroke statistics. 2010 update: a report from the American Heart Association. Circulation. 2010;121(7):e46-e215. doi:10.1161/CIRCULATIONAHA.109.192667
• Matta AG, Yaacoub N, Nader V, Moussallem N, Carrie D, Roncalli J. Coronary artery aneurysm: a review. World J Cardiol. 2021;13(9):446-455. doi:10.4330/wjc.v13.i9.446
• Luo Y, Tang J, Liu X, et al. Coronary artery aneurysm differs from coronary artery ectasia: angiographic characteristics and cardiovascular risk factor analysis in patients referred for coronary angiography. Angiology. 2017; 68(9):823-830. doi:10.1177/0003319716665690
• Abou Sherif S, Ozden Tok O, Taşköylü Ö, Goktekin O, Kilic ID. Coronary artery aneurysms: a review of the epidemiology, pathophysiology, diagnosis, and treatment. Front Cardiovasc Med. 2017;4(1):24. doi:10.3389/fcvm.2017.00024
• Eftekhar-Vaghefi SH, Pourhoseini S, Movahedi M, et al. Comparison of detection percentage and morphology of myocardial bridge between conventional coronary angiography and coronary CT angiography. J Cardiovasc Thorac Res. 2019;11(3):203-208. doi:10.15171/jcvtr.2019.34
• Villa AD, Sammut E, Nair A, Rajani R, Bonamini R, Chiribiri A. Coronary artery anomalies overview: the normal and the abnormal. World J Radiol. 2016;8(6):537-555. doi:10.4329/wjr.v8.i6.537
• Evbayekha EO, Nwogwugwu E, Olawoye A, et al. A comprehensive review of myocardial bridging: exploring diagnostic and treatment modalities. Cureus. 2023;15(8):e43132. doi:10.7759/cureus.43132
• Roberts W, Charles SM, Ang C, et al. Myocardial bridges: a meta-analysis. Clin Anat. 2021;34(5):685-709. doi:10.1002/ca.23697
• Yasuma K, Takata S, Yuasa T, et al. Bilateral coronary artery fistulas with multiple sites of drainage. Jpn Circ J. 1998;62(10):783-784.
• Kumar R, Kumar J, O’Connor C, et al. Coronary artery fistula: a diagnostic dilemma. Interv Cardiol. 2023;18:e25. doi:10.15420/icr.2022.34
• Ripley DP, Saha A, Teis A, et al. The distribution and prognosis of anomalous coronary arteries identified by cardiovascular magnetic resonance: 15 year experience from two tertiary centres. J Cardiovasc Magn Reson. 2014;16(1):34. doi:10.1186/1532-429X-16-34
• Click RL, Holmes DR Jr, Vlietstra RE, Kosinski AS, Kronmal RA. Anomalous coronary arteries: location, degree of atherosclerosis and effect on survival--a report from the coronary artery surgery study. J Am Coll Cardiol. 1989;13(3):531-537. doi:10.1016/0735-1097(89)90588-3