Prevalence and Characteristics of Coronary Anomalies Originating from the Opposite Sinus of Valsalva in 8,522 Patients Referred for Coronary Computed Tomography Angiography

doi:10.1016/j.amjcard.2013.01.280

The American Journal of Cardiology

Volume 111, Issue 9, 1 May 2013, Pages 1361-1367

https://doi.org/10.1016/j.amjcard.2013.01.280 Get rights and content

Although coronary computed tomographic angiography has the ability to depict potentially malignant features of anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS), there are limited data on the significance of ACAOS in the computed tomography population. The aims of this study were to assess the prevalence of ACAOS and to correlate its anatomic features with patients' symptoms among 8,522 consecutive subjects who underwent coronary computed tomographic angiography from February 2008 to May 2012. The ACAOS proximal course was classified into anterior, interarterial, septal, and retroaortic subtypes. Malignant ACAOS was recorded if a slitlike ostium, an acute angle of takeoff, an intramural course, and significant compression between the aorta and pulmonary trunk were present simultaneously. The prevalence of ACAOS was 0.84% (72 of 8,522), including right-sided origins of the left main coronary artery (n = 11), left anterior descending coronary artery (n = 9), and left circumflex coronary artery (n = 33) and left-sided origin of the right coronary artery (n = 20). Of the 24 ACAOS (0.28%) with an interarterial course, 12 (0.14%) showed significant vessel compression, of which 6 (0.07%) were classified as malignant. The presence of significant interarterial compression and malignant ACAOS type were observed in left-sided right coronary arteries only, and interarterial compression correlated with patients' symptoms at a median of 15-month follow-up. In conclusion, the computed tomographic prevalence of ACAOS seems to be comparable with that of previous angiographic studies. The malignant features of ACAOS in the adult computed tomography population might be exclusively associated with left-sided right coronary arteries.

Section snippets

Methods

We reviewed retrospectively a database of 8,928 consecutive patients who were referred for CCTA from February 2008 to May 2012 to the Institute of Cardiology in Warsaw, Poland. The computed tomographic reports were analyzed for the presence of ACAOS, and those with (1) right-sided origin of the left main coronary artery (LMCA), (2) right-sided origin of the left anterior descending coronary artery (LAD), (3) right-sided origin of the left circumflex artery (LC), and (4) left-sided origin of the

Results

Of the 8,522 subjects, 7,447 (87%) and 1,075 (13%) underwent computed tomography because of suspected and known coronary artery disease, respectively. The median age was 60 ± 11 years (range 12 to 93), and 4,222 patients (49%) were male.

The prevalence of ACAOS was 0.84% (72 of 8,522). Among the 72 patients, there was a total of 73 ACAOS (1 patient had 2 coronary anomalies: LAD and LC originating separately from the right aortic sinus). Clinical characteristics are listed in Table 1. The median

Discussion

The present study demonstrates that (1) the prevalence of ACAOS by CCTA is comparable with that seen in previous angiographic studies, and (2) the malignant anatomic and clinical characteristics of ACAOS in an adult CCTA population might be exclusively associated with left-sided origin of the RCA. In addition, we have shown a relatively good clinical prognosis at short-term follow-up in most patients with ACAOS treated conservatively. Notably, the present report is the second after the study of

References (18)

F.S. Torres et al.
Role of MDCT coronary angiography in the evaluation of septal vs interarterial course of anomalous left coronary arteries
J Cardiovasc Comput Tomogr
(2010)
H. Xu et al.
Anomalous coronary arteries: depiction at dual-source computed tomographic coronary angiography
J Thorac Cardiovasc Surg
(2012)
C. Basso et al.
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)
W.C. Roberts et al.
Origin of the right coronary artery from the left sinus of Valsalva and its functional consequences: analysis of 10 necropsy patients
Am J Cardiol
(1982)
R.E. Eckart et al.
Sudden death in young adults: a 25-year review of autopsies in military recruits
Ann Intern Med
(2004)
B.J. Maron et al.
Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States 1980-2006
Circulation
(2009)
P. Angelini et al.
Anomalous coronary artery arising from the opposite sinus: descriptive features and pathophysiologic mechanisms, as documented by intravascular ultrasonography
J Invasive Cardiol
(2003)
Y. Jo et al.
Sudden cardiac arrest associated with anomalous origin of the right coronary artery from the left main coronary artery
Tex Heart Inst J
(2011)
S. Kaushal et al.
Intramural coronary length correlates with symptoms in patients with anomalous aortic origin of the coronary artery
Ann Thorac Surg
(2011)

There are more references available in the full text version of this article.

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Congenital heart diseasePrevalence and Characteristics of Coronary Anomalies Originating from the Opposite Sinus of Valsalva in 8,522 Patients Referred for Coronary Computed Tomography Angiography

Section snippets

Methods

Results

Discussion

J Cardiovasc Comput Tomogr

J Thorac Cardiovasc Surg

J Am Coll Cardiol

Am J Cardiol

Sudden death in young adults: a 25-year review of autopsies in military recruits

Ann Intern Med

Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States 1980-2006

Circulation

Anomalous coronary artery arising from the opposite sinus: descriptive features and pathophysiologic mechanisms, as documented by intravascular ultrasonography

J Invasive Cardiol

Sudden cardiac arrest associated with anomalous origin of the right coronary artery from the left main coronary artery

Tex Heart Inst J

Intramural coronary length correlates with symptoms in patients with anomalous aortic origin of the coronary artery

Ann Thorac Surg

Congenital heart disease
Prevalence and Characteristics of Coronary Anomalies Originating from the Opposite Sinus of Valsalva in 8,522 Patients Referred for Coronary Computed Tomography Angiography