Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2021; 31(01): 138-149
DOI: 10.1055/s-0041-1730135
Original Article

Prevalence Rates of Congenital Coronary Anomalies and Coronary Variations in Adult Indian Population Using Dual-Source Computed Tomography Coronary Angiography: Analysis of Regional Distribution of Coronary Anomalies and the Need for Standardized Reporting Formats

Kartik P. Ganga  
1   Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
,
Aayush Goyal  
2   Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
,
Vineeta Ojha  
1   Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
,
Siddharthan Deepti
3   Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
,
Sanjiv Sharma
1   Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
,
Sanjeev Kumar
1   Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Congenital coronary artery anomalies (CCAA) are predominantly discovered as incidental findings on computed tomography coronary angiography (CTCA) of adults. They are rare but significant, considering their importance during endovascular or surgical interventions. This study describes the prevalence of CCAA and coronary variants (CV) in adults as identified by CTCA.

Methods It is a retrospective evaluation of 7,694 CTCAs of adults performed in a tertiary care facility in North India.

Results CCAA and CV were observed in a total of 9.6% of patients. The most common CV was myocardial bridging, observed in 7.1%. Anomalies of origin and course were detected in 2.3% of the patients. The frequency of these anomalies in the right coronary artery, left main, left circumflex artery, and the left anterior descending artery arteries were 1.06, 0.41, 0.03, and 0.38%, respectively. The single coronary pattern was seen in 0.05% and coronary artery fistulas in 0.03%. Scrutiny of data on Indian regional distribution revealed differing definitions and inclusion and exclusion criteria, making comparisons difficult, highlighting the need for uniform definitions as well as the need to adopt a standardized reporting template and format.

Conclusion The prevalence of CCAA and CV is 9.6% in adult Indian patients undergoing CTCA. Prior knowledge of these anatomical finding can prevent a catastrophe during surgery or endovascular interventions. Hence, it is important that clinicians, as well as radiologists, are aware of these entities.

Keywords

computed tomography coronary angiography - coronary artery anomalies - coronary variations

*These authors contributed equally.


Supplementary Material



Publication History

Article published online:
01 June 2021

© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Tuzcu EM, Moodie DS, Chambers JL, Keyser P, Hobbs RE. Congenital heart diseases associated with coronary artery anomalies. Cleve Clin J Med 1990; 57 (02) 147-152
    CrossrefPubMedGoogle Scholar
  • 2 Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990; 21 (01) 28-40
    CrossrefPubMedGoogle Scholar
  • 3 Angelini P, Velasco JA, Flamm S. Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation 2002; 105 (20) 2449-2454
    CrossrefPubMedGoogle Scholar
  • 4 Rigatelli G, Cardaioli P. Endovascular therapy for congenital coronary artery anomalies in adults. J Cardiovasc Med (Hagerstown) 2008; 9 (02) 113-121
    CrossrefPubMedGoogle Scholar
  • 5 Garg N, Tewari S, Kapoor A, Gupta DK, Sinha N. Primary congenital anomalies of the coronary arteries: a coronary: arteriographic study. Int J Cardiol 2000; 74 (01) 39-46
    CrossrefPubMedGoogle Scholar
  • 6 Angelini P. Coronary artery anomalies: an entity in search of an identity. Circulation 2007; 115 (10) 1296-1305
    CrossrefPubMedGoogle Scholar
  • 7 Sundaram B, Kreml R, Patel S. Imaging of coronary artery anomalies. Radiol Clin North Am 2010; 48 (04) 711-727
    CrossrefPubMedGoogle Scholar
  • 8 Yadav A, Buxi T, Sudarshan H, Jayamma SS, Rawat KS, Ghuman SS. Clinico-radiological correlation of coronary artery anomalies in Indian subcontinent. Astrocyte 2015; 1: 277-287
    CrossrefGoogle Scholar
  • 9 Rao A, Pimpalwar Y, Yadu N, Yadav RK. A study of coronary artery variants and anomalies observed at a tertiary care armed forces hospital using 64-slice MDCT. Indian Heart J 2017; 69 (01) 81-86
    CrossrefPubMedGoogle Scholar
  • 10 Sinha P, Saxena S, Jethani SL, Khare S, Jain S, Mehrotra N. Major primary congenital coronary artery anomalies: an angiographic study. J Anat Soc India 2012; 61: 172-176
    CrossrefGoogle Scholar
  • 11 Sidhu NS, Wander GS, Monga A, Kaur A. Incidence, characteristics and atherosclerotic involvement of coronary artery anomalies in adult population undergoing catheter coronary angiography. Cardiol Res 2019; 10 (06) 358-368
    CrossrefPubMedGoogle Scholar
  • 12 Diwan Y, Diwan D, Chauhan RS, Negi PC. Coronary artery anomalies in North Indian population: a conventional coronary angiographic study. Natl J Clin Anat 2017; 06: 250-257
    Google Scholar
  • 13 Sirasapalli CN, Christopher J, Ravilla V. Prevalence and spectrum of coronary artery anomalies in 8021 patients: a single center study in South India. Indian Heart J 2018; 70 (06) 852-856
    CrossrefPubMedGoogle Scholar
  • 14 Sakthivel MK, Mathew RP, Wakade AD. et al. 128-Slice MDCT angiographic evaluation of coronary artery anomalies in the South Asian (Indian) population – a first experience. J Indian Coll Cardiol 2017; 7: 116-122
    CrossrefGoogle Scholar
  • 15 Prasad S, Vijayakumar DH. Detection of coronary artery anomalies using 64 slice MDCT angiography. Int J Contemp Med Surg Radiol 2017; 2: 75-79
    Google Scholar
  • 16 Aiyappan SK. Vadanika V, Karpagam B, Vinayagam S, Saravanan KC. Role of MDCT-Coronary angiography in the evaluation of coronary artery anomalies and incidence of coronary artery anomalies in a subset of South Indian population. J Evol Med Dent Sci 2015; 4: 15561-15565
    Google Scholar
  • 17 Majumdar S, Krishnan H, Kumar A. TCT-488 congenital coronary anomalies of origin and distribution in adult patients referred for coronary angiography. J Am Coll Cardiol 2020; 68 (Suppl. 18) B195-B196
    Google Scholar
  • 18 Sivakumar GS, Selvarani G, Kumar SS, Ramesh R, Hemanath TR, Manikandan D. Incidence of coronary artery anomalies among patients undergoing coronary angiography and its relevance to appropriate choice of coronary catheter selection-a tertiary care center study. Int J Sci Stud 2017; 5: 228-231
    Google Scholar
  • 19 Raval A, Jadhav N, Prajapati J. et al. Distribution of coronary artery anomalies and their evaluation with different imaging modalities. Int J Med Res Rev 2016; 4: 1807-1819
    CrossrefGoogle Scholar
  • 20 Lingaraju S, Maurya RK, Sanghvi S. A study of incidence and pattern of coronary artery anomalies in Western Rajasthan, India. Int J Res Med Sci 2017; 4: 3388-3393
    Google Scholar
  • 21 Nawale JM, Chaurasia AS, Nalawade DD, Choudalwar P, Borikar N, Tiwari D. Study of clinical profile, incidence, pattern, and atherosclerotic involvement of congenital coronary artery anomalies in adults undergoing coronary angiography: a study from a tertiary care institute in western part of India. Heart India 2018; 6: 133-140
    CrossrefGoogle Scholar
  • 22 Srinivasan KG, Gaikwad A, Kannan BRJ, Ritesh K, Ushanandini KP. Congenital coronary artery anomalies: diagnosis with 64 slice multidetector row computed tomography coronary angiography: a single-centre study. J Med Imaging Radiat Oncol 2008; 52 (02) 148-154
    CrossrefPubMedGoogle Scholar
  • 23 Schmitt R, Froehner S, Brunn J. et al. Congenital anomalies of the coronary arteries: imaging with contrast-enhanced, multidetector computed tomography. Eur Radiol 2005; 15 (06) 1110-1121
    CrossrefPubMedGoogle Scholar
  • 24 Kim SY, Seo JB, Do KH. et al. Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation. Radiographics 2006; 26 (02) 317-333, discussion 333–334
    CrossrefPubMedGoogle Scholar
  • 25 Shi H, Aschoff AJ, Brambs HJ, Hoffmann MHK. Multislice CT imaging of anomalous coronary arteries. Eur Radiol 2004; 14 (12) 2172-2181
    CrossrefPubMedGoogle Scholar
  • 26 Arjmand Shabestari A. Coronary artery calcium score: a review. Iran Red Crescent Med J 2013; 15 (12) e16616
    PubMedGoogle Scholar
  • 27 Alegria JR, Herrmann J, Holmes Jr DR, Lerman A, Rihal CS. Myocardial bridging. Eur Heart J 2005; 26 (12) 1159-1168
    CrossrefPubMedGoogle Scholar
  • 28 Ko SM, Choi JS, Nam CW, Hur SH. Incidence and clinical significance of myocardial bridging with ECG-gated 16-row MDCT coronary angiography. Int J Cardiovasc Imaging 2008; 24 (04) 445-452
    CrossrefPubMedGoogle Scholar
  • 29 Spindola-Franco H, Grose R, Solomon N. Dual left anterior descending coronary artery: angiographic description of important variants and surgical implications. Am Heart J 1983; 105 (03) 445-455
    CrossrefPubMedGoogle Scholar
  • 30 Cury RC, Abbara S, Achenbach S. et al. Endorsed by the American College of Cardiology. CAD-RADS™: Coronary artery disease - reporting and data system: an expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). J Am Coll Radiol 2016; 13 (12) 1458-1466.e9
    CrossrefPubMedGoogle Scholar
  • 31 Mery CM, Lawrence SM, Krishnamurthy R. et al. Anomalous aortic origin of a coronary artery: toward a standardized approach. Semin Thorac Cardiovasc Surg 2014; 26 (02) 110-122
    CrossrefPubMedGoogle Scholar
  • 32 Molossi S, Martínez-Bravo LE, Mery CM. Anomalous aortic origin of a coronary artery. Methodist DeBakey Cardiovasc J 2019; 15 (02) 111-121
    PubMedGoogle Scholar