Anomalous course of coronary arteries
Updates to Article Attributes
Anomalous course of a coronary artery is a type of congenital coronary artery anomaly. It may represent a benign and incidental finding, but can also be a malignant course predisposing patients to life threatening-threatening myocardial ischaemia or arrhythmias, depending on where the artery runs.
Clinical presentation
MajorityThe majority of anomalous coronary artery courses, approximately 80%, are benign in approximately 80% and are asymptomatic however. However, in rare occasions, thisit can result in ischaemia, arrhythmias or sudden death. Most symptomatic patients are young.
Pathology
The aberrantcoronary artery may have a benign or malignant course if they pass pass between the aorta and the main pulmonary artery (so, representing a so-called inter-arterial course). When this is the case, it It may be associated with a "slit-like" orifice with an acute angle course at the ostium which is more prone to occlusion. SpeciallyEspecially during physical activity, also the artery may be compressed and the flow within it compromised. For this reason this condition is called malignantmay be compromised. Presence of a "slit-like" orifice or intramural course of the coronary artery within the aortic wall is more predictive of adverse outcome than the interarterialinter-arterial course alone.
AnThere are four common courses for an anomalous coronary artery arising from the opposite sinus usually takes four common courses 4,5:
- malignant course:
- inter-arterial (i.e. between the aorta and the pulmonary artery): this is the most dangerous as it carries a high risk of sudden cardiac death
- benign course:
- retroaortic
- prepulmonic
- septal (subpulmonic)
Treatment and prognosis
Treatment of anomalous coronary artery isarteries is controversial particularly. Particularly patients with a benign course are rarely needs surgicalneed surgical treatment. However, in symptomaticSymptomatic patients with an inter-arterial course may require surgical "re-implantation" of the anomalous coronary artery or "de-roofing", if an intramural course is present.
-<p><strong>Anomalous course of a coronary artery</strong> is a type of <a href="/articles/congenital-coronary-artery-anomalies">congenital coronary artery anomaly</a>. It may represent a benign and incidental finding, but can also be a malignant course predisposing patients to life threatening myocardial ischaemia or arrhythmias, depending on where the artery runs. </p><h4>Clinical presentation</h4><p>Majority are benign in approximately 80% and are asymptomatic however in rare occasions, this can result in ischaemia, arrhythmias or sudden death. Most symptomatic patients are young.</p><h4>Pathology</h4><p>The aberrant artery may have a benign or malignant course if they pass between the aorta and the main pulmonary artery (so-called inter-arterial course). When this is the case, it may be associated with "slit-like" orifice with acute angle course at the ostium which is more prone to occlusion. Specially during physical activity, also the artery may be compressed and flow within it compromised. For this reason this condition is called malignant. Presence of a "slit-like" orifice or intramural course of the coronary artery within the aortic wall is more predictive of adverse outcome than the interarterial course alone.</p><p>An anomalous coronary artery arising from the opposite sinus usually takes four common courses <sup>4,5</sup>:</p><ul>- +<p><strong>Anomalous course of a coronary artery</strong> is a type of <a href="/articles/congenital-coronary-artery-anomalies">congenital coronary artery anomaly</a>. It may represent a benign and incidental finding, but can also be a malignant course predisposing patients to life-threatening myocardial ischaemia or arrhythmias, depending on where the artery runs. </p><h4>Clinical presentation</h4><p>The majority of anomalous coronary artery courses, approximately 80%, are benign and are asymptomatic. However, in rare occasions, it can result in ischaemia, arrhythmias or sudden death. Most symptomatic patients are young.</p><h4>Pathology</h4><p>The coronary artery may pass between the aorta and the main pulmonary artery, representing a so-called inter-arterial course. It may be associated with a "slit-like" orifice with an acute angle course at the ostium which is more prone to occlusion. Especially during physical activity, the artery may be compressed and the flow within it may be compromised. Presence of a "slit-like" orifice or intramural course of the coronary artery within the aortic wall is more predictive of adverse outcome than the inter-arterial course alone.</p><p>There are four common courses for an anomalous coronary artery arising from the opposite sinus <sup>4,5</sup>:</p><ul>
-</ul><h4>Treatment and prognosis</h4><p>Treatment of anomalous coronary artery is controversial particularly patients with benign course are rarely needs surgical treatment. However, in symptomatic patients with an inter-arterial course may require surgical "re-implantation" of the anomalous coronary artery or "de-roofing", if intramural course is present.</p>- +</ul><h4>Treatment and prognosis</h4><p>Treatment of anomalous coronary arteries is controversial. Particularly patients with a benign course rarely need surgical treatment. Symptomatic patients with an inter-arterial course may require surgical "re-implantation" of the anomalous coronary artery or "de-roofing", if an intramural course is present.</p>
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