Skip to main content
SpringerLink
Log in

Coronary Artery Anatomy and Anomalies

  • Chapter
  • First Online:
Textbook of Catheter-Based Cardiovascular Interventions

  • 710 Accesses

Abstract

Congenital coronary artery anomalies are not common, but it is crucial to identify them as in some cases they can cause myocardial ischemia, arrhythmias, and sudden cardiac death. It is also important to identify variants and anomalies without clinical relevance on their own, as complications during surgery or catheter-based interventions can occur. The aim of this chapter is to give a comprehensive and concise overview of coronary embryology and normal coronary artery anatomy, describe common variants of normal anatomy, and summarize typical patterns of anomalous coronary artery anatomy. We described three groups according to their frequency in the general population: normal, normal variant, and anomaly. We have further subdivided the anomalies based on their functional relevance: coronary artery anomalies with obligatory ischemia, without ischemia, or with exceptional ischemia. The chapter is complemented by images taken from invasive coronary angiography, coronary computed tomography, and cardiac magnetic resonance to help illustrate the nature of the anomalies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Reese DE, Mikawa T, Bader DM. Development of the coronary vessel system. Circ Res. 2002;91:761–8.

    Article  CAS  PubMed  Google Scholar 

  2. Young PM, Gerber TC, Williamson EE, Julsrud PR, Herfkens RJ. Cardiac imaging: part 2, normal, variant, and anomalous configurations of the coronary vasculature. Am J Roentgenol. 2012;197:816–26.

    Article  Google Scholar 

  3. Angelini P. Normal and anomalous coronary arteries: definitions and classification. Am Heart J. 1989;117:418.

    Article  CAS  PubMed  Google Scholar 

  4. Van der Velden LBJ, Bär FWHM, Meursing BTJ, Ophuis TJMO. A rare combination of coronary anomalies. Neth Hear J. 2008;16:387–9.

    Article  Google Scholar 

  5. Goldsmith JB, Butler HW. The development of the cardiac–coronary circulatory system. Am J Anat. 1937;60:185.

    Article  Google Scholar 

  6. Clark EB. Cardiac embryology: its relevance to congenital heart disease. Am J Dis Child. 1986;140:41–4.

    Article  CAS  PubMed  Google Scholar 

  7. Conte G, Pellegrini A. On the development of the coronary arteries in human embryos, stages 14–19. Anat Embryol. 1984;169:209–18.

    Article  CAS  Google Scholar 

  8. Angelini P. Clinical articles: coronary artery anomalies—current clinical issues: definitions, classification, incidence, clinical relevance, and treatment guidelines. Tex Heart Inst J. 2002;29:271.

    PubMed  PubMed Central  Google Scholar 

  9. Angelini P, Velasco JA, Flamm S. Coronary anomalies incidence, pathophysiology, and clinical relevance. Circulation. 2002;105:2449–54.

    Article  PubMed  Google Scholar 

  10. Angelini P. Coronary artery anomalies an entity in search of an identity. Circulation. 2007;115:1296–305.

    PubMed  Google Scholar 

  11. Raff GL, Abidov A, Achenbach S, Berman DS, Boxt LM, Budoff MJ, Cheng V, Tony D, Hellinger JC, Karlsberg RP. SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr. 2009;3:122–36.

    Article  PubMed  Google Scholar 

  12. Menke DM, Waller BF, Pless JE. Hypoplastic coronary arteries and high takeoff position of the right coronary ostium. A fatal combination of congenital coronary artery anomalies in an amateur athlete. Chest. 1985;88:299–301.

    Article  CAS  PubMed  Google Scholar 

  13. Flessas D, Mamarelis I, Maniatis V. An unusual pattern of three major components of the cardiovascular system: multimodality imaging and review of the literature. J Cardiothorac Surg. 2013;8:61.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Shriki JE, Shinbane JS, Rashid MA, Hindoyan A, Withey JG, DeFrance A, Cunningham M, Oliveira GR, Warren BH, Wilcox A. Identifying, characterizing, and classifying congenital anomalies of the coronary arteries. Radiographics. 2012;32:453–68.

    Article  PubMed  Google Scholar 

  15. Apitzsch J, Kühl HP, Muhlenbruch G, Mahnken AH. Unusual malignant coronary artery anomaly: results of coronary angiography, MR imaging, and multislice CT. Cardiovasc Intervent Radiol. 2009;33:389–93.

    Article  PubMed  Google Scholar 

  16. Karadag B, Ayan F, Ismailoglu Z, Goksedef D, Ataev Y, Vural VA. An extraordinary cause of ischemic chest pain in a young man: congenital ostial atresia of the right coronary artery. J Cardiol. 2009;54:335–8.

    Article  PubMed  Google Scholar 

  17. Chiribiri A, Ishida M, Nagel E, Botnar RM. Coronary imaging with cardiovascular magnetic resonance: current state of the art. Prog Cardiovasc Dis. 2011;54:240–52.

    Article  PubMed  Google Scholar 

  18. Boffano C, Chiribiri A, Cesarani F. Native whole-heart coronary imaging for the identification of anomalous origin of the coronary arteries. Int J Cardiol. 2009;137:e27–8.

    Article  PubMed  Google Scholar 

  19. Angelini P, Trujillo A, Sawaya F, Lee V-V. “Acute takeoff” of the circumflex artery: a newly recognized coronary anatomic variant with potential clinical consequences. Tex Heart Inst J. 2008;35:28.

    PubMed  PubMed Central  Google Scholar 

  20. Frescura C, Basso C, Thiene G, Corrado D, Pennelli T, Angelini A, Daliento L. Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol. 1998;29:689–95.

    Article  CAS  PubMed  Google Scholar 

  21. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Catheter Cardiovasc Diagn. 1990;21:28–40.

    Article  CAS  Google Scholar 

  22. Morales AR, Romanelli R, Tate LG, Boucek RJ, De Marchena E. Intramural left anterior descending coronary artery: significance of the depth of the muscular tunnel. Hum Pathol. 1993;24:693–701.

    Article  CAS  PubMed  Google Scholar 

  23. Leon F, Salazar H, Moreira W, Angelini P. Daughter, you broke my heart: accidental thrombosis at a muscular bridge. Tex Heart Inst J. 2006;33:380.

    PubMed  PubMed Central  Google Scholar 

  24. Juillière Y, Berder V, Suty-Selton C, Buffet P, Danchin N, Cherrie F. Isolated myocardial bridges with angiographic milking of the left anterior descending coronary artery: a long-term follow-up study. Am Heart J. 1995;129:663–5.

    Article  PubMed  Google Scholar 

  25. Konen E, Goitein O, Sternik L, Eshet Y, Shemesh J, Di Segni E. The prevalence and anatomical patterns of intramuscular coronary arteries: a coronary computed tomography angiographic study. J Am Coll Cardiol. 2007;49:587–93.

    Article  PubMed  Google Scholar 

  26. De Rosa R, Sacco M, Tedeschi C, Pepe R, Capogrosso P, Montemarano E, Rotondo A, Runza G, Midiri M, Cademartiri F. Prevalence of coronary artery intramyocardial course in a large population of clinical patients detected by multislice computed tomography coronary angiography. Acta Radiol. 2015;49:895–901.

    Article  Google Scholar 

  27. Ferreira AG Jr, Trotter SE, König B Jr, Decourt LV, Fox K, Olsen EG. Myocardial bridges: morphological and functional aspects. Br Heart J. 1991;66:364–7.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Koester MC. A review of sudden cardiac death in young athletes and strategies for preparticipation cardiovascular screening. J Athl Train. 2001;36:197–204.

    PubMed  PubMed Central  Google Scholar 

  29. Yurtdas M, Gülen O. Anomalous origin of the right coronary artery from the left anterior descending artery: review of the literature. Cardiol J. 2012;19:122.

    Article  PubMed  Google Scholar 

  30. Sloan K, Majdalany D, Connolly H, Schaff H. Inferior wall myocardial infarction caused by anomalous right coronary artery. Can J Cardiol. 2008;24:S102–3.

    Article  Google Scholar 

  31. Venturini E, Magni L. Single coronary artery from the right sinus of Valsalva. Heart Int. 2011;6:e5.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Basso C, Olivotto I, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol. 2000;35:1493–501.

    Article  CAS  PubMed  Google Scholar 

  33. Davies JE, Burkhart HM, Dearani JA, Suri RM, Phillips SD, Warnes CA, Sundt TM III, Schaff HV. Surgical management of anomalous aortic origin of a coronary artery. Ann Thorac Surg. 2009;88:844–8.

    Article  PubMed  Google Scholar 

  34. Cacici G, Angelini P. Unusual case of single coronary artery: questions of methods and basic concepts. Ital Heart J. 2005;6:345–7.

    PubMed  Google Scholar 

  35. Angelini P, Walmsley RP, Libreros A, Ott DA. Symptomatic anomalous origination of the left coronary artery from the opposite sinus of valsalva: clinical presentations, diagnosis, and surgical repair. Tex Heart Inst J. 2006;33:171–9.

    PubMed  PubMed Central  Google Scholar 

  36. Dodge-Khatami A, Mavroudis C, Backer CL. Congenital heart surgery nomenclature and database project: anomalies of the coronary arteries. Ann Thorac Surg. 2000;69:270–97.

    Article  Google Scholar 

  37. Roberts WC. Major anomalies of coronary arterial origin seen in adulthood. Am Heart J. 1986;111:941–63.

    Article  CAS  PubMed  Google Scholar 

  38. Peña E, Nguyen ET, Merchant N, Dennie C. ALCAPA syndrome: not just a pediatric disease. Radiographics 2009;29:553–65.

    Article  PubMed  Google Scholar 

  39. Alexander RW, Griffith GC. Anomalies of the coronary arteries and their clinical significance. Circulation. 1956;14:800.

    Article  CAS  PubMed  Google Scholar 

  40. Alexi-Meskishvili V, Nasseri BA, Nordmeyer S, Schmitt B, Weng Y-G, Böttcher W, Hübler M, Berger F, Hetzer R. Repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children. J Thorac Cardiovasc Surg. 2011;142:868–74.

    Article  PubMed  Google Scholar 

  41. Baitaxe HA, Wixson D. The incidence of congenital anomalies of the coronary arteries in the adult population 1. Radiology. 1977;122:47–52.

    Article  Google Scholar 

  42. Camarda J, Berger S. Coronary artery abnormalities and sudden cardiac death. Pediatr Cardiol. 2012;33:434–8.

    Article  PubMed  Google Scholar 

  43. Frommelt PC, Frommelt MA, Tweddell JS, Jaquiss RD. Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course. J Am Coll Cardiol. 2003;42:148–54.

    Article  PubMed  Google Scholar 

  44. Click RL, Holmes DR, 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;13:531–7.

    Article  CAS  PubMed  Google Scholar 

  45. Bunce NH, Lorenz CH, Keegan J, Lesser J, Reyes EM, Firmin DN, Pennell DJ. Coronary artery anomalies: assessment with free-breathing three-dimensional coronary MR angiography 1. Radiology. 2003;227:201–8.

    Article  PubMed  Google Scholar 

  46. Sawaya FJ, Sawaya JI, Angelini P. Split right coronary artery its definition and its territory. Tex Heart Inst J. 2008;35:477.

    PubMed  PubMed Central  Google Scholar 

  47. Gulel O, Yazici M, Durna K, Demircan S. Images in cardiology: a rare coronary anomaly: double right. Clin Cardiol. 2007;30:309.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Erbagci H, Davutoglu V, Turkmen S, Kizilkan N, Gumusburun E. Double right coronary artery: review of literature. Int J Cardiovasc Imaging. 2006;22:9–11.

    Article  PubMed  Google Scholar 

  49. Hongsakul K, Suwannanon R. Congenital absence of left circumflex artery detected by computed tomography coronary angiography: a case report. Case Rep Vasc Med. 2012;2012:1–3.

    Google Scholar 

  50. Roberts WC, Glick BN. Congenital hypoplasia of both right and left circumflex coronary arteries. Am J Cardiol. 1992;70:121–3.

    Article  CAS  PubMed  Google Scholar 

  51. Said SA, Van der Werf T. Dutch survey of congenital coronary artery fistulas in adults: coronary artery–left ventricular multiple micro-fistulas. Int J Cardiol. 2006;110:33–9.

    Article  CAS  PubMed  Google Scholar 

  52. Kassaian SE, Mahmoodian M, Salarifar M, Alidoosti M, Abbasi SH, Rasekh A. Stent-graft exclusion of multiple symptomatic coronary artery fistulae. Tex Heart Inst J. 2007;34:199.

    PubMed  PubMed Central  Google Scholar 

  53. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Int J Cardiovasc Imaging (Internet). 2002;18:539–42. Available from: http://circ.ahajournals.org/cgi/doi/10.1161/hc0402.102975.

    Google Scholar 

  54. Clemente A, Del Borrello M, Greco P, Mannella P, Di Gregorio F, Romano S, Morra A. Anomalous origin of the coronary arteries in children: diagnostic role of three-dimensional coronary MR angiography. Clin Imaging. 2010;34:337–43.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Biomedical Engineering and Imaging Sciences, King’s College London, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK

    Adriana D. M. Villa & Amedeo Chiribiri

Authors
  1. Adriana D. M. Villa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amedeo Chiribiri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adriana D. M. Villa .

Editor information

Editors and Affiliations

  1. Middle German Heart Center and Health Care Center Bitterfeld-Wolfen, gGmbH, Bitterfeld-Wolfen, Germany

    Peter Lanzer

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Villa, A.D.M., Chiribiri, A. (2018). Coronary Artery Anatomy and Anomalies. In: Lanzer, P. (eds) Textbook of Catheter-Based Cardiovascular Interventions. Springer, Cham. https://doi.org/10.1007/978-3-319-55994-0_30

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-55994-0_30

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-55993-3

  • Online ISBN: 978-3-319-55994-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation