Coronary artery anomalies in adult patients.

BACKGROUND

Coronary artery anomalies are discovered in less than 1% of angiography series. Since the number of angiographies and coronary bypass operations are increasing significantly every day, these anomalies are of clinical importance.

MATERIAL/METHODS: 58,023 coronary angiographies were performed in the cardiology clinic of our hospital from 1978 to 2001. Coronary artery anomalies were discovered in 257 of these cases (0.44%). The mean age of these patients was 51.9+/-11.4 years (18-82). 80% were male (n=207).

RESULTS

The circumflex artery (CXA) was the most frequently involved vessel (51.1%). Coronary arteries originating from the pulmonary artery were not encountered in our series due to the natural history of the disease. In 54 patients with coronary artery fistulae, 18 (33.3%) were closed by operation. Perioperative mortality was 5.5%. Acquired coronary artery fistulae or aneurysms due to trauma or inflammatory diseases are completely different entities and beyond the scope of this article. In 76 patients, open heart surgery was required for additional lesions, 57 of which were coronary artery bypass grafts.

CONCLUSIONS

Being usually asymptomatic, coronary artery anomalies are usually discovered incidentally in the adult population. These pathologies are important for practical purposes, especially for interventional cardiologists, radiologists and cardiac surgeons, who should be aware of these anatomical entities. LMCA originating from the right coronary system has been reported to result in sudden death and myocardial ischemia, so these mostly asymptomatic patients must be followed closely.