Circulation. 2002;105:2449-2454
doi: 10.1161/01.CIR.0000016175.49835.57
doi: 10.1161/01.CIR.0000016175.49835.57
(Circulation. 2002;105:2449.)
© 2002 American Heart Association, Inc.
Current Perspective |
Coronary Anomalies
Incidence, Pathophysiology, and Clinical Relevance
From the Departments of Adult Cardiology (P.A., J.A.V.) and Radiology (S.F.), Texas Heart Institute at St Luke’s Episcopal Hospital, Houston, Tex.
Correspondence to Paolo Angelini, MD, PO Box 20206, Houston, TX 77030. E-mail leachman@ix.netcom.com
Key Words: coronary disease • death, sudden • heart arrest • heart disease, congenital • coronary artery anomalies
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Introduction |
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Coronary artery anomalies are some of the most confusing, neglected topics in cardiology. Although the medical community and general public are increasingly aware that coronary anomalies can be fatal (typically in young, previously "healthy" athletes),1 the reasons for the sudden fatal event and the frequency with which it occurs are generally unclear. To promote a less casual approach to this subject, we review some basic, substantive, and methodological questions about coronary anomalies.
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Definitions and Incidence |
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According to the literature, coronary anomalies affect
1% of the general population; this percentage is derived from cineangiograms performed for suspected obstructive disease.2–4 Necropsies yield an even lower incidence: in 18 950 necropsies, Alexander and Griffith5 observed only 54 coronary anomalies (0.3%). Unfortunately, these studies are limited by entry biases and a lack of clear diagnostic criteria.
Angelini and coworkers6 propose that, because of its substantial variability, normal and anomalous coronary anatomy should be characterized. Accordingly, an anomaly should be defined as any coronary pattern with a feature (number of ostia, proximal course, termination, etc) "rarely" encountered in the general population. By determining the incidence of anatomic variants in a large population, acceptable definitions of normal and anomalous anatomy could be established and the clinical importance of anomalous variants ascertained. Ideally, this effort would be overseen by an expert ad hoc committee and would generate a rational paradigm, perhaps along the lines of Table 1. Previous authors have proposed a preemptive anatomo-clinical classification that considers anomalies as "major" or "minor" (ie, incapable of causing relevant clinical consequences)2,7–10
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