Zukić Fuad, Miljko Miro, Vegar-Zubović Sandra, Behmen Adi, Arapović Antonela Krasić
Clinic of Radiology, Clinical Center University of Sarajevo, Bolnička 25, 71000 Sarajevo, Bosnia & Hercegovina,
Psychiatr Danub. 2017 Dec;29 Suppl 4(Suppl 4):830-834.
Coronary artery anomalies (CAAs) are congenital variations of one or more of the coronary arteries and they are an uncommon but important cause of chest pain and, in some cases, sudden cardiac death. Anomalies of coronary arteries may be found incidentally in 0.3-1% of healthy individuals. The three types of coronary artery anomalies are anomalies of origin, anomalies of course and anomalies of termination. The purpose of our study was to estimate the frequency of CAAs in Canton Sarajevo, B&H, and to deteremine the prevalence of origin, course and termination anomalies of coronary arteries.
This was a retrospective analysis of 919 patients who underwent Coronary CT Angiography to determine CAAs in the period from 2013 to 2017.
In our study, total number of CAAs have been found among the 130 patients (14.12%) out of which anomalies of origin are found at 14 patients (1.52%), anomalies of course at 115 patients (12.5%) and anomaly of termination in 1 patient (0.1%). Out of 14 cases in total anomalies of origin, anomalies of origin of the left coronary artery are observed among 11 patients (1.2%), and anomalies of origin of the right coronary artery among 3 patients (0.3%). From mentioned 14 cases of the anomalous origin of the coronary arteries, anomalies with clinical significance (interarterial, malignant course) of the coronary arteries are found among 6 patients (0.65%) and anomalies without clinical significance are found among 8 patients (0.87%). Coronary artery anomalies of origin with malignant course are devided in two groups: LMA from right sinus of Valsalva with interarterial course observed in 4 patients (0.43%) and RCA from left sinus of Valsalva, also with interarterial course in 2 patients (0.21%). We found 4 patients (0.43%) with separated origin LAD and LCX, without LMA. The preavlence rates of separate origin of RCA and conus artery, anomaly origin of the LCX from right coronary sinus, anomaly origin of the LMA from posterior coronary sinus and LMA from right coronary sinus without interarterial course were seen in 0.1% of patients. Among 115 cases of anomalies of course 111 cases (12.07%) belongs to bridging (37 cases to LAD; 25 cases to D1 and D2 and 49 to ramus intermedius), and 4 cases (0.43%) belongs to intraatrial course of RCA. Anomaly of termination presented with fistula between LCX and coronary sinus was found only in 1 case.
Coronary CT angiography is an excellent tool for diagnosis of CAAs regarding origin, course and termination of the coronary arteries.
冠状动脉异常（CAAs）是指一条或多条冠状动脉的先天性变异，是胸痛的少见但重要原因，在某些情况下可导致心源性猝死。健康个体中偶然发现冠状动脉异常的比例为0.3%-1%。冠状动脉异常分为起源异常、走行异常和终止异常三种类型。本研究的目的是评估波斯尼亚和黑塞哥维那萨拉热窝州CAAs的发生率，并确定冠状动脉起源、走行和终止异常的患病率。
这是一项对919例在2013年至2017年期间接受冠状动脉CT血管造影以确定CAAs的患者的回顾性分析。
在我们的研究中，130例患者（14.12%）发现有CAAs，其中起源异常14例（1.52%），走行异常115例（12.5%），终止异常1例（0.1%）。在总共14例起源异常中，左冠状动脉起源异常11例（1.2%），右冠状动脉起源异常3例（0.3%）。在上述14例冠状动脉起源异常中，具有临床意义（动脉间、恶性走行）的冠状动脉异常6例（0.65%），无临床意义的异常8例（0.87%）。具有恶性走行的冠状动脉起源异常分为两组：4例（0.43%）为发自右冠状动脉窦的左主干且走行于动脉间，2例（0.21%）为发自左冠状动脉窦的右冠状动脉且走行于动脉间。我们发现4例（0.43%）患者左前降支和左旋支起源分离，无左主干。右冠状动脉和圆锥动脉起源分离、左旋支起源于右冠状动脉窦、左主干起源于后冠状动脉窦以及发自右冠状动脉窦且不走行于动脉间的左主干的患病率均为0.1%。在115例走行异常中，111例（12.07%）属于桥接（37例至左前降支；25例至第一对角支和第二对角支；49例至中间支），4例（0.43%）属于右冠状动脉心房内走行。仅1例发现终止异常表现为左旋支与冠状窦之间存在瘘管。
冠状动脉CT血管造影是诊断冠状动脉起源、走行和终止方面CAAs的优秀工具。
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