Imaging and Management of Coronary Artery Anomalies
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Imaging (Q Truong, Section Editor)
Imaging and Management of Coronary Artery Anomalies Mohamed Sayyouh, MBBCH1,* Elizabeth Lee, MD1 Nicole Bhave, MD2 Karen Kim, MD3 Prachi P. Agarwal, MBBS1 Address *,1 Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan Health Service, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA Email: [email protected] 2 Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA 3 Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
Published online: 10 October 2020 * Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Imaging Keywords Coronary I Anomalies I Imaging I Management
Abstract Purpose of review To highlight imaging features of coronary artery anomalies, especially those that may require surgical intervention, and review various management options. Recent findings The clinical presentation of coronary artery anomalies ranges from clinically silent lesions to those leading to sudden cardiac death. With the evolution and increasing use of advanced imaging techniques such as computed tomography, more cases are being identified on scans either done specifically for this purpose or discovered incidentally. Management decisions can be complex and often require a multidisciplinary approach. Summary In this article, we review advances in imaging techniques, the spectrum of imaging appearances of coronary artery anomalies, and the role of imaging in directing appropriate management as well as post-operative follow-up.
Introduction Coronary artery anomalies are rare but are the second most common cause of sudden cardiac death in young athletes [1] highlighting the need for appropriate
identification. Depending on the methodology for diagnosis (i.e., autopsy versus imaging), the prevalence of
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Curr Treat Options Cardio Med (2020) 22: 40
coronary artery anomalies is estimated to be 0.21–5.8% [2]. Multiple classification systems for coronary artery anomalies exist and typically use anatomic features including the site of origin, vessel course, size, and number of vessels involved. Specific morphologic and anatomic characteristics (e.g., slit-like ostium, intramural course, and interarterial course between the aorta and pulmonary artery) are associated with poor outcomes and often require surgical management [3, 4]. Identification and description of these features in reports by the cardiac imager are critical for directing appropriate treatment.
In this review, we highlight imaging features of coronary artery anomalies with a special emphasis on those that need intervention. This article describes the role and strengths of various modalities such as echocardiography, coronary computed tomography angiography (CCTA), and cardiac magnetic resonance imaging (CMR) and illustrates cross-sectional imaging appearance of coronary artery anomalies. Clinical and imaging considerations that go into de
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