Congenital anomalies of the coronary circulation

Editors in Chief: Eli Gelfand, M.D. and C. Michael Gibson, M.S., M.D.

Associate Editors in Chief: Arnoldas Giedrimas, M.D.

Overview
The diagnosis of a congenital anomaly in the coronary circulation is often may on coronary angiography, CMR, or CT angiography. Stress testing can be used to evaluate the functional risk of ischemia.

Anomalous Origin of the Circumflex Artery

 * The origin is from the posterior aortic sinus
 * Retroaortic course
 * Posterior AV groove course

Anomalous Right Coronary Artery

 * Origin from left sinus of Valsalva
 * Origin from the left anterior descending artery (LAD)
 * Can lead to MI, sudden cardiac death

Atypical origin of the Left Coronary Artery
The left coronary artery originates from the pulmonary artery in the Bland-White-Garland syndrome. This results in:
 * Low perfusion pressure
 * Hypoxemia
 * May lead to coronary artery steal, and left to right shunt

Atypical origin of the Left Anterior Descending Artery (LAD)

 * Aortic root
 * Right sinus of Valsalva, Right Coronary Artery (RCA)
 * LAD course between aorta and PA may result in compression with exercise
 * This variant is associated with Tetralogy of Fallot

Atypical origin of LCx

 * Aortic root
 * R sinus of Valsalva, RCA
 * course posterior to L ventricle, generally benign

Tetralogy of Fallot

 * LAD may originate from RCA, courses across pulmonary outflow tract

Other Cogential Heart Diseases in which There Can Be An Anomalous Origin of the Coronary Arteries

 * Transposition of the great arteries
 * Double outlet right ventricle
 * Truncus arteriosus

Additional Reading

 * Moss and Adams' Heart Disease in Infants, Children, and Adolescents Hugh D. Allen, Arthur J. Moss, David J. Driscoll, Forrest H. Adams, Timothy F. Feltes, Robert E. Shaddy, 2007 ISBN 0781786843
 * Hurst's the Heart, Fuster V, 12th ed. 2008, ISBN 978-0-07-149928-6
 * Willerson JT, Cardiovascular Medicine, 3rd ed., 2007, ISBN 978-1-84628-188-4