Clinical Features and Management of Patients with an Anomalous Origin of the Coronary Arteries

Abstract

Background: An anomalous origin of a coronary artery is a rare congenital condition in which a coronary artery arises from the opposite coronary sinus. Most coronary artery anomalies are an incidental finding without clinical signifi -cance, although some cases may be potentially life threat-ening, depending on the origin, course and termination of the anomalous vessel. Anatomical features of risk are an aortic intramural course or inter-arterial course. Methods: We present 4 cases of an anomalous origin of the coronary arteries with radiological confirmation by cardiac computed tomography angiography (CCTA) and clinical history of chest pain. Two patients were incidentally diagnosed by invasive coronary angiography, while two of them under-went a CCTA exam directly. Ischemia detection tests such as treadmill test or myocardial perfusion imaging with single photon emission computed tomography (SPECT) were performed in all of them to rule out ischemia. Results: In all 4 cases, none relationship between clinical symptoms and anatomical features was established. Once ischemia was ruled-out by ischemia detection tests, we chose clinical follow-up instead of surgery given the ab-sence of anatomical or risk clinical features. Conclusion: Only a minority of patients have symptoms due to these coronary anomalies. An expectant attitude with periodical surveillance seems to be the best option in patients with low-risk variants of coronary artery anomalies without clinical documentation of myocardial ischemia.