BACKGROUND: Congenital anomalies of the coronary arteries are not common. They comprise less than 0.46 percent of congenital malformatins of the heart. Clinically they are asymptomatic or may result in increased cardiac morbidity and mortality.
OBJECTIVE: To determine the incidence and describe anomalous congenital coronary arteries in patients who underwent coronary angiography at SLMC from 1994 up to 2004
METHODS: This is a descriptive study of all patients who underwent coronary angiography at St. Luke's Medical Center from 1994 to 2004 suspected for coronary artery disease. The angiograms were reviewed to look for anomalous congenital coronary artery. The medical records of subjects with anomalous arteries were reviewed for cardiac history, physical signs and symptoms including co-morbid conditions.
RESULTS: From 1994 to 2004, there were 9,766 patients who underwent coronary angiography at St. Luke's Medical Center. Sixty-eight patients (0.69 percent) were found to have anomalous congenital coronary artery. There were 43 (63.2 percent) males and 25 (36.7 percent) females with a mean age of 55 years. Anomalous origin of the right coronary artery from left coronary sinus were found in 24 patients (35 percent), coronary artery fistula 18 (26 percent); anomalous origin of left coronary artery from right coronary sinus 8 (12 percent); coronary-cameral fistula 6 (9 percent); absent left main trunk 4 (6 percent); congenitally absent RCA 2 (3 percent) and absent LCx2 (3 percent) and 1 anomalous origin of left coronary artery from main pulmonary artery, 1 anomalous origin of OM from LAD, 1 anomalous origin of RCA from aorto-superior portion of right sinus, and 1 anomalous origin of LM above aortic ridge. Chest pain was present in 47 (69 percent) patient and 6 (8.8 percent) were asymptomatic. Associated co-morbid conditions were hypertension 41 (60 percent), dyslipidemia 21 (35 percent) and diabetes in 24 (31 percent). Sixteen patients (23 percent) had inducible ischemia on stress test. Right coronary artery dominance was found in 58 (85 percent) patients and type II LAD in 49 (72 percent). Significant coronary artery disease was seen in 29 (43 percent) patients while 21 (31 percent) patients had normal coronary angiograms.
CONCLUSION: The incidence of congenital coronary artery anomaly is 1 percent in our population and the most common anomaly noted was anomalous origin of right coronary artery from left coronary sinus. (Author)