Imaging techniques and patient work-up in coronary artery anomalies

Congress:

ECR 2020

Poster Number:

C-13471

Type:

Educational Exhibit

Keywords:

Not applicable, Ischaemia / Infarction, Congenital, Normal variants, MR, Echocardiography, CT-Angiography, Management, Cardiovascular system, Cardiac

Authors:

A. Ciuni, A. Palumbo, N. Sverzellati; Parma/IT

DOI:

10.26044/ecr2020/C-13471

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-13471

Fig. 1: Conventional origin of coronary arteries

Table 1: Coronary Artery Anomalies - Classification

Fig. 3: Morphological features of CAA

Learning objectives

To illustrate the epidemiology, signs and symptoms of benign and malignant coronary artery anomalies (CAA) To review the role of the different imaging methods, including cardiac ultrasound, invasive coronary angiography, computed tomography angiography, magnetic resonance angiography and myocardial perfusion single-photon emission tomography in the diagnosis and management of affected patients, understanding when surgical treatment in indicated.

Background

CAA are the variants of origin, number and the relative different course compared to the normal condition. CAA represent the second cause of sudden cardiac death (SCD) (12-19%) under the age of 35, after hypertrophic cardiomyopathy (36%). SCD usually occurs during or immediately after intense exercise. In most cases (55%), CAA are clinically silent and are recognized only at the time of autopsy with less than 10% of subjects receiving a correct pre-mortem cardiological evaluation [1].

Findings and procedure details

The prevalence of CAA is not high (1-2%), but early diagnosis and adequate clinical management are important, therefore it is necessary to rule out CAA inyoung athletes with symptoms (such as syncope, chest pain, arrhythmia). It is useful in this group of patients to find a "non-invasive" screening tool that replaces traditional coronary angiography. There are different systematic classifications of CAA based on their anatomical features as indicated by Kim. et al., modified from Greenberg classification: [Table 1] anomalies of origin, course and termination. CAA...

Conclusion

Non-invasive techniques are nowadays the standard for an accurate diagnosis of CAA, with very low or no radiation exposure The radiological findings help the adequate work-up of the affected patients in order of preventing SCD.

Personal information and conflict of interest

A. Ciuni; Parma/IT - nothing to disclose A. Palumbo; Parma/IT - nothing to disclose N. Sverzellati; Parma/IT - nothing to disclose

References

1.10.1161/01.CIR.0000016175.49835.57 2.10.1148/rg.262055068 3.10.1016/j.jacc.2017.01.031 4.10.1007/s00330-004-2490-2 5.10.1067/S0894-7317(03)00554-6 6.10.1016/s0735-1097(00)01136-0 7.10.1016/0002-9149(93)91120-7 8.10.1007/s00246-010-9871-x 9.10.1186/1532-429X-16-34 10. 10.1007/s00330-005-2707-z 11. 10.1007/s11547-010-0566-4 12. 10.1007/s00330-007-0821-9 13. 10.1016/j.jacc.2018.08.1028 14. 10.1177/2150135114540182 15. 10.1007/s12350-015-0342-x