Clinical Articles: Coronary Artery Anomalies—Current Clinical Issues: Definitions, Classification, Incidence, Clinical Relevance, and Treatment Guidelines
ABSTRACT The study of coronary artery anomalies would benefit from the clarification of various fundamental issues, including the definitions, classification, incidence, pathophysiologic mechanisms, and clinical relevance of each anomaly. The greatest challenge is to identify the abnormality and determine its clinical relevance so that appropriate treatment can be instituted. Currently, the coronary anatomy is essentially defined by the features of the (conductive) epicardial coronary tree and its dependent territory. Therefore, one must consider all the possible and observed variations in anatomic features that are used to describe the coronary arteries. We propose that the left anterior descending, circumflex, and right coronary arteries be considered the essential elementary units of coronary anatomy. We also suggest that the coronary arteries be defined not by their origin or proximal course, but by their intermediate and distal segments or dependent microvascular bed. A strict classification system is necessary before meaningful data can be gathered about the incidence of coronary anomalies. With respect to clinical relevance, the greatest challenge is presented by anomalies that only occasionally cause critically severe clinical events and are otherwise compatible with a normal life. In such cases, it is not known whether the specific features of a given anomaly cause adverse clinical consequences, or whether additional episodic factors are required. To correlate subclassifiable anatomic and functional features with clinical events and prognoses, a large, multicenter database, relying on prospective, coordinated protocols, is urgently needed. In the absence of established official guidelines, we present practical protocols for diagnosing and treating coronary anomalies.
- SourceAvailable from: Carlos E UribeRevista Colombiana de Cardiologia 04/2012; 19(2):96-99.
- [Show abstract] [Hide abstract]
ABSTRACT: 12 years old patient, with ecocardiography suspecting anomalous origin of circumflex coronary artery studied with MR coronary angiography.
- [Show abstract] [Hide abstract]
ABSTRACT: Case report A previously healthy 6 year-old boy with no significant past medical or family history suddenly began vomiting in the evening after spending part of the day working with his father. He continued to vomit through the night and was taken to his pediatrician, who immediately drove him to the local emergency department. Physical examination and laboratory findings were consistent with cardiogenic shock. Electrocardiography showed diffusely low voltage, and echocardiography revealed poor left ventricular function. Hemodynamic stability could not be maintained despite IV fluids, dopamine, and multiple attempts at cardiopulmonary resuscitation. The patient was placed on cardiopulmonary bypass and transfer to a tertiary medical facility was arranged. After approximately 3 h on bypass, transport arrived and the patient was converted to a portable Extracorporeal Membrane Oxygenation (ECMO) circuit and transferred. On arrival, examination revealed a diffusely edematous, unresponsive p ...Forensic Science Medicine and Pathology 10/2014; 11(1). DOI:10.1007/s12024-014-9612-1 · 1.96 Impact Factor