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Coronary artery anomaly


Anomalies of the coronary arteries include anomalous origin of the left or right coronary artery and abnormal course of the coronary arteries from the aorta to the surface of the heart. Here we discuss anomalous origin of the left coronary artery from the pulmonary artery. Congenital coronary arteriovenous fistula is a direct connection of the coronary artery to a cardiac chamber or to one of the major veins of the heart.

Morphology

Figure 25-1, A Anomalous origin of left coronary artery from pulmonary artery. The specimen is opened to the outlet portion of the left ventricle and the aortic root through the noncoronary sinus of Valsalva. The ascending aorta and arch (identified by its aortic branches) and the upper portion of the descending aorta are demonstrated. There is only one coronary artery orifice seen in the aortic root. B Anomalous origin of left coronary artery from pulmonary artery, magnified view. The single large coronary artery orifice is identified as the right coronary artery. There is no coronary artery orifice in the left coronary sinus. The noncoronary sinus aorta has been divided along with the valve, and there is no identifiable coronary artery in this sinus either. C Anomalous origin of left coronary artery from pulmonary artery. The right ventricle (RV) is opened anteriorly into the anterior wall of the pulmonary artery. The small left coronary artery orifice is identified on the posterior aspect of the pulmonary artery. D Anomalous origin of left coronary artery from pulmonary artery, magnified view. The left coronary artery originates from the posterior sinus of Valsalva of the pulmonary artery. The ascending aorta and arch are seen emerging from behind the pulmonary artery. The distance from the origin of the left coronary artery to the ascending aorta can be appreciated by studying the dimensional aspects of this image. E Anomalous origin of left coronary artery from pulmonary artery, operative view. This photograph shows dilation of the right coronary artery and dilated branches forming the collateral circulation to the left coronary artery. F Anomalous origin of left coronary artery from pulmonary artery, operative view. This photograph in another patient shows even more pronounced dilation of the right coronary artery, compensating for the pulmonary artery origin of the left coronary artery. G Coronary artery–to–cardiac chamber fistula, operative view. This photograph is from a patient with a right coronary artery fistula to the right ventricle. The pronounced dilation of the right coronary artery is comparable to that seen in Figure 25-1 , F . The difference is that the dilation is confined to the main channel of the right coronary artery; the branch arteries are normal. H Coronary artery–to–cardiac chamber fistula, operative view. The exposure is through the right atrium. The fistulous opening of the right coronary artery to the right ventricle is located just below the atrioventricular groove and the septal leaflet of the tricuspid valve.

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