• Anomaly
• Coronary artery
• Coronary computed tomography angiography
• Prevalence
• Variant

• Humans
• Coronary Vessel Anomalies/diagnostic imaging
• Coronary Vessel Anomalies/epidemiology
• Female
• Male
• Computed Tomography Angiography/methods
• Computed Tomography Angiography/statistics & numerical data
• Prevalence
• Middle Aged
• Coronary Angiography/methods
• Coronary Angiography/statistics & numerical data
• Aged
• Retrospective Studies
• Adult
• Aged, 80 and over

• Humans
• Coronary Vessel Anomalies/diagnostic imaging
• Coronary Angiography/methods
• Diagnosis, Differential

• Arterial switch operation
• High reimplantion of coronary arteries
• High take-off coronary arteries
• Transposition of the great arteries

• CT coronary angiography
• anatomy
• anomalies
• coronary arteries
• variants

• anomalous origin of the right coronary artery
• atherosclerotic cardiovascular disease
• congenital cardiac malformation
• coronary artery bypass grafting (cabg)
• left heart catheterization
• mechanical compression
• multidetector computed tomography (mdct)
• nuclear stress test
• sudden cardiac death (scd)
• transesophageal echocardiography (tee)

• Athletes
• Coronary CT angiography
• Coronary artery anomalies
• Coronary artery disease
• Diagnostic imaging
• Personalized medicine
• Pre-participation screening
• Specialist agonistic suitability visit
• Sports medicine
• Sudden cardiac death

• Humans
• Computed Tomography Angiography/methods
• Death, Sudden, Cardiac/prevention & control
• Athletes
• Coronary Angiography/methods
• Mass Screening/methods
• Coronary Artery Disease/diagnostic imaging
• Italy
• Adolescent

• congenital coronary artery anomaly
• coronary artery anomaly (caa)
• embryological coronary artery anomaly
• left circumflex artery
• left coronary artery anomaly
• left main coronary artery
• right sinus of valsalva
• takotsubo cardiomyopathy
• takotsubo-like cardiomyopathy

• No. PWZxg-11 2022 Key discipline group of cardiology fund, sanitation and health committee of Pudong New Area

• angina
• coronary artery
• coronary computed tomography angiography (CCTA)
• dual left anterior descending artery (LAD)
• myocardial bridge

• social sciences
• public health
• arrhythmias

• Humans
• Arrhythmias, Cardiac/diagnosis
• Wearable Electronic Devices
• Electrocardiography
• Algorithms
• Supervised Machine Learning

• National Key R&D Program of China (no.2018YFC2001203). Key Laboratory of Medical Image Processing of Guangdong Provincial (no. 2020B1212060039).

• coronary artery
• situs inversus
• truncus arteriosus

• CABG
• Coronary artery bypass surgery, Dual LAD
• Coronary artery disease
• Dual left anterior descending artery, CAD

Congenital absence of the left main coronary artery is a very rare entity. The literature surrounding this presentation describes it as a fairly common cause of sudden death especially in early life. Some schools of thought hypothesize that for the few cohorts who live into their adulthood with this anomaly, serious cardiovascular complications usually ensue.

We present a case of a generally healthy and asymptomatic 67-year-old gentleman with a history of diagnosed congenital absence of the left main coronary artery since age six without any active cardiovascular complaints at baseline.

Coronary artery anomalies (CAAs) are rare anatomical variations characterized by abnormal origin, course, or termination of the coronary arteries. This study aims to identify incidental CAAs in patients who underwent multidetector computed tomography coronary angiography (MDCTCA) to determine their incidence and to evaluate whether there is a difference between CAA types in terms of coronary atherosclerotic involvement. For this purpose, patients who underwent MDCTCA between December 2018 and January 2022 were retrospectively assessed. Of the 5200 MDCTCAs analyzed, CAAs were detected in 136 patients (2.61%). Of these 136 patients, 37 (27.2%) patients had an origin anomaly, 97 (71.3%) had a course anomaly, and 2 (1.5%) had a termination anomaly. There was no statistically significant difference between CAA types in terms of atherosclerotic involvement (p = 0.220). However, atherosclerotic involvement was high in vessels with anomalies when normal vessels with and without anomalies were compared (p = 0.005). Accurate detection of CAAs is vital for endovascular treatment or surgical intervention. MDCTCA is helpful both in the diagnosis of CAA and in the early detection and development of prevention strategies for coronary atherosclerosis.

• Coronary Angiography/methods
• Coronary Artery Disease/diagnostic imaging
• Coronary Artery Disease/epidemiology
• Coronary Vessel Anomalies/diagnostic imaging
• Coronary Vessel Anomalies/epidemiology
• Humans
• Multidetector Computed Tomography
• Prevalence
• Retrospective Studies

• Coronary Vessels/diagnostic imaging
• Fistula
• Heart/diagnostic imaging
• Humans
• Sympathectomy
• Sympathetic Nervous System

In the typical course of the coronary arteries, the right coronary artery comes from the right coronary sinus and descends in the right atrioventricular groove. The left coronary artery trunk begins from the left coronary sinus. It crosses the pulmonary trunk and divides into left anterior descending and left circumflex arteries. Anatomical differences of the coronary arteries can be observed in 0.3–5.6% of the population. The interarterial course of coronary branches between the aorta and the pulmonary trunk is a malignant anomaly of the coronary arteries. Such abnormalities have been associated with an increased risk of sudden cardiac death. We present a rare case of coronary arteries anomaly involving the presence of a single right coronary artery and the interarterial course of its atypical branches documented by computed tomography angiography (CTA). In summary, the accurate assessment of the anatomical topography of coronary anomalies, possible in CTA, is necessary in the analysis of the risk of sudden cardiac death and its prevention.

심장 전산화단층촬영(이하 CT)은 현재 관상동맥기형을 진단하고, 평가하는 가장 정확한 진단 도구로 자리매김하였으며, 심장 CT 촬영 건수가 증가함에 따라 관상동맥기형을 종종 관찰할 수 있다. 본 종설은 관상동맥기형에서 영상의학과 의사들이 꼭 알아야 할 대표적인 기형의 CT 소견들에 대해 다루었다. 관상동맥기형의 종류를 3부분 즉, 기시부, 동맥 내, 그리고 연결 부위로 나누어 설명하였으며, 임상에서 볼 수 있는 대표적인 기형들 중심으로 다루었다. 특히 혈역학적 이상을 유발하거나, 급사의 위험이 있는 기형들의 CT상 위험한 해부학적 소견에 대해서는 자세히 기술하였다.

• cardiovascular research
• congenital heart disease
• coronary artery disease

Myocardial crypts are discrete, narrow, blood filled invaginations within the left ventricular myocardium and high-take-off coronary artery are rare manifestations where coronary arteries originate above the sinotubuler junction.

A 41-year-old man with multiple coronary artery disease risk factors admitted to our outpatient department with progressive dyspnea and atypical chest pain. Physical examination revealed no pathological findings. His blood examination revealed only mild to moderately high IgE and LDL levels. Transthoracic echocardiography (TTE) was normal. His treadmill test was normal, yet in the 3rd stage of the test he had an atypically located chest pain which was relieved in the resting period. As he had multiple cardiovascular risk factors, we performed a coronary CT angiography to exclude coronary artery disease. Coronary CT angiography(CCTA) demonstrated multiple myocardial crypts, a muscular VSD like defect which were not detectable with TTE and a high take off left main coronary artery (LMCA). After CCTA, we repeated the TTE to investigate the crypts and VSD-like defect which were clear on CCTA, yet a precise TTE hardly showed crypts and didn’t confirm a shunt between the left and right ventricle. We defined the defect as ‘spontaneously closed muscular VSD’. None of these pathologies were clinically relevant with the patient’s symptoms, thus pneumonology started a montelukast therapy for 1 year and we decided to follow up the patient, as multiple crypts may indicate an early phase hypertrophic cardiomyopathy.

Considering that a high take-off LMCA is a congenital anomaly, encountering multiple crypts which are also congenital pathologies, is plausible, as congenital anomalies may accompany eachother. Echocardiography is a very useful, practical imaging tool but regrettably may be suboptimal due to various patient and method related reasons. Target combination of different cardiovascular imaging tools like echocardiography, cardiac CT(CCT), may be utilized in order to ensure a comprehensive diagnosis particularly.

• Cardiac CT
• High take-off coronary arteries
• Left ventricular crypts

To analyze the imaging features of coronary artery-to-pulmonary artery fistula (CPAF) on coronary computed tomography angiography (CCTA).

This was a retrospective study of 3,975 patients who underwent 320 row detector CCTA examinations in our hospital from May 2015 to July 2020. A total of 22 patients who diagnosed with CPAF were reviewed for CCTA imaging characteristics, including the origin, number, blood volume, opening size, and course of fistula vessels, and the drainage site, size, and imaging features of the fistula. All cases were analyzed for the presence of coronary atherosclerotic plaque and that of deficient left ventricular myocardial perfusion.

A total of 22 CPAF cases detected by CCTA were collected (men, 11; women, 11; median age, 59.6±10.1 years). There were 7, 10, and 5 cases detected with 1, 2, and 3 fistula vessels, respectively, among which 4 originated from the left coronary artery, 4 from the right coronary artery, and 14 had bilateral origins. There were 10 cases in which the fistula vessels presented as a worm-like tortuous dilation with (n=5) or without (n=5) aneurysm, while 12 cases showed malformed vascular networks with (n=8) or without (n=4) aneurysm, respectively. The calculated incidence of aneurysm formation was 59.09%, and fistula vessels with an aneurysm had larger blood volume than those without. All fistula showed a single drainage site, with an average diameter of 2.81±1.48 mm where the diameter of fistula with aneurysm was larger than that without. The fistula vessels drained into the left anterolateral and anterior walls of main pulmonary artery and the proximal left inferior PA, respectively. Typical jet sign, smoke sign, and isodensity sign were presented in 22, 14 and 1 case, respectively. For the coexistent abnormalities analyzed in 22 cases, 17 participants with CPAF demonstrated hypoperfusion of the fistula vessels, and 11 demonstrated calcified plaque accompanied with luminal stenosis to different degrees.

The 320-row detector CCTA can comprehensively characterize the morphological features of CPAF, which is an optimal choice for physicians to make an accurate assessment before formulating patient management strategies.

• 320 row detector X-ray computed tomography
• Coronary artery-to-pulmonary artery fistula (CPAF)
• coronary computed tomography angiography (CCTA)

• Coronary artery anomalies
• Coronary computed tomographic angiography (CCTA)
• Interarterial
• Intraseptal
• Sudden death

Recent technological advances, together with an increasing body of evidence from randomized trials, have placed coronary computer tomography angiography (CCTA) in the center of the diagnostic workup of patients with coronary artery disease. The method was proven reliable in the diagnosis of relevant coronary artery stenosis. Furthermore, it can identify different stages of the atherosclerotic process, including early atherosclerotic changes of the coronary vessel wall, a quality not met by other non-invasive tests. In addition, newer computational software can measure the hemodynamic relevance (fractional flow reserve) of a certain stenosis. In addition, if required, information related to cardiac and valvular function can be provided with specific protocols. Importantly, recent trials have highlighted the prognostic relevance of CCTA in patients with coronary artery disease, which helped establishing CCTA as the first-line method for the diagnostic work-up of such patients in current guidelines. All this can be gathered in one relatively fast examination with minimal discomfort for the patient and, with newer machines, with very low radiation exposure. Herein, we provide an overview of the current technical aspects, indications, pitfalls, and new horizons with CCTA, providing examples from our own clinical practice.

• CCTA
• chronic coronary syndromes
• diagnosis coronary artery disease
• plaque analysis
• prognosis
• review

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.

• computed tomography coronary angiography
• coronary artery anomalies
• coronary variations

• Computed tomography
• Coronary CT angiography
• Coronary anomalies
• Innovative biotechnologies
• Radiation dose

Aortic root dilation and aortic insufficiency are prominent causes of morbidity in Marfan syndrome. These pathologies necessitate surgical repair, including aortic root and aortic valve replacement procedures, to improve prognosis. Coronary artery aneurysms, particularly giant coronary ostial aneurysms, are rare complications of these surgeries in the Marfan population. Due to the significant life-threatening sequelae of coronary artery aneurysms, it is imperative to bring attention regarding this complication to the radiologist assessing thoracic imaging in this patient population.

• aortic root replacement
• coronary artery aneurysm
• imaging
• marfan syndrome
• ostial aneurysm

• Anomalous coronary artery
• Aortic root
• Children
• Computed tomographic angiography
• Coronary arteries
• Heart
• Interarterial course
• Intramural segment
• Three-dimensional
• Virtual endoluminal views

• Acute coronary syndrome
• Intravascular imaging
• Intravascular ultrasound
• Optical coherence tomography
• Percutaneous coronary intervention

• cardiac surgery
• cardiology
• ent
• imaging

• Cardiac computed tomography
• Cardiac magnetic resonance
• Congenital heart disease
• Pediatric imaging

• Children
• Congenital heart disease
• Coronary artery anomalies
• Coronary artery imaging
• Dual-source computed tomography
• Heart

Coronary artery anomalies (CAAs) are uncommon congenital abnormalities with a prevalence ranging from 0.2–2%. CAAs can be asymptomatic or less commonly present with life-threatening symptoms. This study aimed to investigate the prevalence and spectrum of CAAs in patients who underwent coronary computed tomography angiography (CCTA) in Oman.

This retrospective study was conducted at the National Heart Centre, Muscat, Oman between September 2012 and August 2018. All consecutive patients who had undergone CCTA were included.

A total of 4,445 patients were included in this study. Of these, 59 patients (1.3%) were diagnosed with CAAs with a mean age of 52.6 years (range: 12–80 years) and an equal gender distribution. Among the patients with CAAs, the majority (69.5%) had anomalous origins from the opposite or non-coronary sinus. Right coronary artery arising from the left coronary sinus was the most common type (33.9%). Fewer patients (18.6%) had left circumflex arising from the right coronary sinus (RCS). Seven patients (11.9%) had left main arising from the RCS. Other CAAs were in the dual left anterior descending artery (8.5%), high coronary artery take-off (6.8%), single coronary ostia (6.8%) and coronary artery fistula (6.8%).

The prevalence of CAAs was 1.3% which is similar to the literature.

• Computed Tomography Angiography
• Coronary Vessel Anomalies
• Oman
• Prevalence

Single coronary artery (SCA) originating from a solitary ostium in the aorta and perfusing the entire myocardium is a very rare congenital anomaly of the coronary artery. Furthermore, a right coronary artery (RCA) arising from the mid segment of the left anterior descending artery (LAD) is an extremely uncommon variation of SCA.

A 76-year-old woman presented a 5-mo history of exertional angina. Selective coronary angiography revealed an SCA, with severe ostial stenosis that originated from the left sinus of Valsalva and bifurcated normally into the LAD and circumflex coronary artery. In addition, an anomalous RCA originated from the mid segment of the LAD as a separate branch. Successful balloon angioplasty and stenting for the SCA ostial stenosis were performed on the patient.

Percutaneous coronary intervention (PCI) of the main trunk for SCA is very similar to PCI of an unprotected left main coronary artery. Although technical difficulties and risks do exist, PCI for severe ostial stenosis of the main trunk is safe and efficacious in selected SCA patients.

• Coronary anomaly
• Single coronary artery
• Left main coronary artery
• Percutaneous coronary intervention
• Case report

Coronary arteries originating from the contralateral (noncoronary) sinus and having an interarterial course, in which they run from the ascending aorta to the pulmonary trunk, is a potentially fatal anomaly. Computed tomography (CT) angiography facilitates the recognition and therapeutic planning of such anomalies because of its ability to acquire high-resolution images of the entire course of the coronary artery, as well as of the accompanying atherosclerotic involvement. The right coronary artery originating from the left coronary sinus is the most prevalent anomaly of this type and usually implies a better prognosis, the interarterial course being classified as "high" or "low", depending on whether it is above or below the level of the pulmonary valve, with consequent stratification of the risk and the treatment. However, it is known that there is a high risk of sudden death among patients with a left coronary artery of anomalous origin from the right sinus. In such cases, surgical treatment is recommended, regardless of whether there are symptoms or evidence of ischemia. Given the importance of those aspects, which can be identified on CT of the chest or CT angiography of the aorta, this pictorial essay aims to illustrate such anomalies to facilitate their recognition and description by radiologists who are not specialists in cardiac imaging.

• Aorta, thoracic/abnormalities
• Aorta, thoracic/diagnostic imaging
• Coronary vessel anomalies/complications
• Coronary vessel anomalies/diagnostic imaging

• ALCAPA
• ARCAPA
• Anomalous course
• Anomalous origin
• Coronary artery anomalies
• Coronary atresia

• Computed Tomography Angiography/methods
• Coronary Angiography/methods
• Coronary Artery Disease/diagnostic imaging
• Coronary Vessel Anomalies/diagnostic imaging
• Humans
• Multidetector Computed Tomography
• Radiographic Image Enhancement/methods

Incidental cardiac findings are often found on chest CT studies, some of which may be clinically significant. The objective of this pictorial review is to illustrate and describe the appearances and management of the most frequently encountered significant cardiac findings on non-electrocardiographically gated thoracic CT. Most radiologists will interpret multidetector chest CT and should be aware of the imaging appearances, significance, and the appropriate next management steps, when incidental significant cardiac disease is encountered on thoracic CT.

This article reviews significant incidental cardiac findings which may be encountered on chest CT studies. After completing this review, the reader should not only be familiar with recognizing clinically significant cardiac findings seen on thoracic CT examinations but also have the confidence to direct their further management.

• Cardiac disease
• Chest computed tomography (CT)
• Incidental finding
• Management
• Significant

• congenital heart disease
• health care delivery

• Aerospace Medicine/methods
• Cardiology/methods
• Consensus
• Disease Management
• Heart Defects, Congenital/therapy
• Humans
• Military Personnel

• Computed tomography coronary angiography
• Conventional catheter angiography
• Coronary artery-to-pulmonary artery fistula
• Transthoracic echocardiogram

Congenital coronary anomalies are uncommon, with an incidence ranging from 0.17% in autopsy cases to 1.2% in angiographically evaluated cases. The recent development of dual-source coronary computed tomography angiography (coronary CTA) allows accurate and noninvasive depiction of coronary artery anomalies.

A retrospective study included a total of 924 patients who underwent coronary CTA because of known or suspected coronary artery disease. In each study, coronary artery anomalies (CAs) were investigated.

A total of 924 patients (mean age 51.2 ± 12.8 years), who underwent dual-source coronary CTA, were studied. The overall prevalence of CAs in our study was 3.7%, with the following distribution: four single coronary artery, 14 anomalous origin from opposite sinus of Valsalva, three absent left main, four high take-off coronary artery, three anomalous left coronary artery from pulmonary artery, and eight coronary artery fistulas.

The present study supports the use of coronary CTA as a reliable noninvasive tool for defining anomalous coronary arteries in an appropriate clinical setting and provides detailed three-dimensional anatomic information that may be difficult to obtain with invasive coronary angiography.

• anomalous coronary artery
• coronary CTA
• prevalence