Coronary Artery Anomalies- State of the Art Review

Coronary artery anomalies (CAAs) comprise a wide spectrum of anatomic entities, with diverse clinical phenotypes. We present a case of an anomalous right coronary artery arising from the left aortic sinus with an interarterial course, a potentially fatal condition that can precipitate ischemia and sudden cardiac death. CAAs are increasingly detected in adults, mostly as incidental findings in the course of cardiac evaluation. This is due to the expanding use of invasive and noninvasive cardiac imaging, usually in the work-up for possible CAD. The prognostic implications of CAAs in this group of patients remain unclear. In AAOCA patients, appropriate work-up with anatomical and functional imaging should be performed for risk stratification. An individualized approach to management should be adopted, considering symptoms, age, sporting activities and the presence of high risk anatomical features and physiologic consequences (such as ischemia, myocardial fibrosis, or cardiac arrhythmias) detected on multimodality imaging or other functional cardiac investigations. This comprehensive and up to date review seeks to crystallize current data in the recent literature, and proposes a clinical management algorithm for the clinician faced with the conundrum of managing such conditions. (Curr Probl Cardiol 2023;48:101935.)

Automated summary

Coronary artery anomalies (CAAs) are a wide range of anatomical abnormalities with varied clinical presentations. We report a case of an anomalous right coronary artery arising from the left aortic sinus with an interarterial course, which can be potentially life-threatening and lead to ischemia and sudden cardiac death. CAAs are increasingly being detected in adults as incidental findings during cardiac evaluation due to the use of invasive and noninvasive cardiac imaging for possible coronary artery disease (CAD). The prognostic significance of CAAs in these patients is still unclear. Appropriate anatomical and functional imaging should be performed for risk stratification in patients with AAOCA. Individualized management approaches should consider symptoms, age, sporting activities, and the presence of high-risk anatomical features and physiologic consequences detected on multimodality imaging or other functional cardiac investigations. This comprehensive review aims to summarize current data and propose a clinical management algorithm for clinicians facing the challenge of managing such conditions. (Curr Probl Cardiol 2023;48:101935.)