CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 9/10, October/November 2013
AFRICA
351
The incidence of coronary anomalies on routine
coronary computed tomography scans
KANBER OCAL KARABAY, ABDULMELIK YILDIZ, GURKAN GECEER, ENDER UYSAL, BAYRAM BAGIRTAN
Abstract
Objective:
This study aimed to assess the incidence of coro-
nary anomalies using 64-multi-slice coronary computed
tomography (MSCT).
Methods:
The diagnostic MSCT scans of 745 consecutive
patients were reviewed.
Results:
The incidence of coronary anomalies was 4.96%. The
detected coronary anomalies included the conus artery origi-
nating separately from the right coronary sinus (RCS) (
n
=
8,
1.07%), absence of the left main artery (
n
=
7, 0.93%), a supe-
rior right coronary artery (RCA) (
n
=
7, 0.93%), the circum-
flex artery (CFX) arising from the RCS (
n
=
4, 0.53%), the
CFX originating from the RCA (
n
=
2, 0.26%), a posterior
RCA (
n
=
1, 0.13%), a coronary fistula from the left anterior
descending artery and RCA to the pulmonary artery (
n
=
1,
0.13%), and a coronary aneurysm (
n
=
1, 0.13%).
Conclusions:
This study indicated that MSCT can be used
to detect common coronary anomalies, and shows it has the
potential to aid cardiologists and cardiac surgeons by reveal-
ing the origin and course of the coronary vessels.
Keywords:
coronary artery anomaly, coronary CT angiography,
coronary artery fistula, coronary aneurysm, myocardial bridging
Submitted 2/4/13, accepted 4/9/13
Published online 11/9/13
Cardiovasc J Afr
2013;
24
: 351–354
DOI: 10.5830/CVJA-2013-066
The incidence of coronary anomalies (CCAs) in a typical
angiographic study was 1.3%.
1
Studies have been conducted
on CCAs using conventional invasive coronary angiography
in highly selected groups of patients but these studies may not
reflect the true incidence of CCAs.
Although the majority of CCAs are benign and incidentally
detected during conventional angiography, certain CCAs may
cause syncope, heart failure or sudden death, especially among
young athletes.
2,3
The US National Registry of Sudden Death in
Athletes at the Minneapolis Heart Institute Registry found that
CCAs were the second most common cause of sudden cardiac
death (out of 17% of the population who died of cardiac-related
causes).
4
Although conventional invasive coronary angiography is
considered the gold standard for the diagnosis of CCAs, trans-
thoracic two-dimensional echocardiography, transoesophageal
echocardiography, magnetic resonance imaging and multi-slice
computed tomography (MSCT) can all identify for diagnosis,
CCAs in certain groups of patients.
5-10
Transthoracic two-
dimensional echocardiography may depict the origin of the
coronary arteries, especially the left main artery, but successful
detection of coronary anomalies depends on the age and size of
the patient.
5,6
Transoesophageal echocardiography has an increased success
rate of identifying coronary anomalies in comparison with
two-dimensional echocardiography. Nevertheless, the position of
the transducer, cardiac motion, and the curvilinear course of the
vessel all affect visualisation of coronary anomalies. Moreover,
transoesophageal echocardiography is a semi-invasive method
and is time consuming.
6,7
Magnetic resonance (MR) imaging provides an accurate
assessment of the course of anomalous coronary arteries.
8,9
However, this technique cannot be performed in patients with
pacemakers, certain types of arrhythmias or defibrillating
devices, and it may be difficult to perform in claustrophobic
patients. Furthermore, the spatial resolution of MR imaging
is substantially inferior to that of the newest generation of CT
scanners.
10
Myocardial bridging (MB) is defined as the compression of
a coronary artery during systole while it is normal in diastole.
MB has been linked to serious cardiac events.
11
The incidence
of myocardial bridging in the population varies substantially
according to invasive coronary angiography (13%) and autopsy
(15–85%).
12,13
The reported incidence of MB has increased up
to 44% when using 64-MSCT.
14
Because of its ability to cause
serious cardiac events, diagnosing MB is clinically important.
MSCT is a minimally invasive method that provides excellent
temporal and spatial resolution of the coronary arteries. There
have been a limited number of studies evaluating CCAs and
MB with 64-MSCT. The aim of this study was to assess the
incidence of CCAs and MB using 64-MSCT in a relatively large
population.
Methods
Our institutional ethics committee approved the study protocol.
Two experienced radiologists and three invasive cardiologists
who were familiar with CCA retrospectively interpreted 745
diagnostic scans of 745 consecutive patients taken between
July 2007 and December 2011 at Istanbul Kadikoy Florence
Nightingale Hospital. Previous reports were not used.
Department of Cardiology, Kadikoy Florence Nightingale
Hospital, Istanbul, Turkey
KANBER OCAL KARABAY, MD,
Department of Cardiology, Avrupa Safak Hospital, Istanbul,
Turkey
ABDULMELIK YILDIZ, MD
BAYRAM BAGIRTAN, MD
Department of Radiology, Kadikoy Florence Nightingale
Hospital, Istanbul, Turkey
GURKAN GECEER, MD
Department of Radiology, Sisli Etfal Research and Training
Hospital, Istanbul, Turkey
ENDER UYSAL, MD
