Author + information
- Rajan Kumar,
- Archana Sinha and
- Jamshid Shirani
Background: Isolated single coronary artery (iSCA), qualified by absence of other major congenital anomalies, is rarely encountered during invasive coronary angiography [ICA (0.014-0.066%)] yet poses diagnostic and therapeutic challenges. Certain subtypes of iSCA are also associated with myocardial ischemia and sudden cardiac death. Early classifications, based on ICA and autopsy (Ogden 1970, Lipton 1979, Shirani/Roberts 1993), were limited by small number of cases and poor spatial display of 2-dimensional ICA. Coronary CT angiography (CCTA) and MRI have rapidly expanded number and subtypes of iSCA with exquisite anatomic details.
Methods: Exhaustive literature search identified 713 adults with iSCA (age 57±14 years, 58% men). There has been rise in reported cases of iSCA with 523 (73%) cases reported in last two decades. Demographic, clinical and coronary anatomy data were collected. Diagnoses were made by ICA [n=391 (55%)], CCTA [n=52 (7%)], ICA+CCTA [n=191 (27%)], autopsy [n=54 (7%)], ICA+MRI or CCTA+MRI or ICA+CCTA+MRI [n=25 (4%)].
Results: Single coronary ostium (SCO) was located in right [R-SCO, n=383 (54%)] or left [L-SCO, n=317, (44%)] coronary sinuses or in ascending aorta [high take-off, n=13 (2%)]. Overall, 15 L-SCO, 18 R-SCO and 3 high take-off variations were identified. Among 36 variations, 4-15% could not be categorized by existing classifications. Myocardial ischemia was reported in 524 (73%) and was caused by atherosclerotic CAD [n=366 (70%)] or was direct result of coronary anomaly [n=158 (30%)]; 258 (36%) underwent coronary intervention [percutaneous: n=187 (26%), surgical: n=71 (10%)].
Conclusions: Attempts at incorporating novel variations of iSCA have been challenging due to limitations of existing classifications. A comprehensive and contemporary classification of iSCA is proposed that can easily accommodate new and as yet unreported (potential) variations. Detailed knowledge of coronary anatomy is relevant to identification of malignant variants and to planning and performing coronary interventions in adults with iSCA.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Things That Begin With an “A” in Adult Congenital Heart Disease: What Is Aorta, Artery and Anomalous?
Abstract Category: 9. Congenital Heart Disease: Adult
Presentation Number: 1232-022
- 2017 American College of Cardiology Foundation