A coronary angiogram, that tends to cross the boundaries of your ideas

A coronary angiogram, that tends to cross the boundaries of your ideas

June 26, 2024 by dr s venkatesan

Video supply and courtesy: Leizhi Ku,, Xiaojing Ma, From the Departments of Radiology (L.Ok.) and Echocardiography (X.M.), Wuhan Asia Coronary heart Hospital, Wuhan, China

Did you guess the prognosis accurately?

It’s a suitable prognosis, should you thought an anomalous LCA, a LAD CTO or a single coronary artery. However, the true prognosis is totally different. It’s left principal atresia .(Which may also be known as a single coronary artery, if RCA offers origin to LCA)

How widespread are coronary artery anomalies?

It’s about 1 to 2%. It may be within the origin, course, and termination. The widespread ones are the unsuitable sinus origin. Proper arising from the left sinus is rather more commoner than left arising from the correct. This subject of anomalous origin wants a separate dialogue. (Prachi P. Agarwal ,et al Radiographics 2017 )

Left principal Atresia: Is it a sub-set of the anomalous origin of LCA from the correct sinus ?

Technically sure, because the left coronary ostium is absent in its designated place in each situations. However, the entity of true Left principal atresia is uncommon and distinctly totally different.The distinction is, that anomalous LCA usually doesn’t journey within the pre-designated path of true LAD and LCX (Ie Intraventricular and Left AV groove). In true atresia, solely the origin is sealed. Remainder of the LCA is anatomically intact , which will get crammed from certainly one of three acquainted Inter arterial collateral (Vieussens, Kugel, and retro-conal coronary ring)

Embryological foundation of coronary artery anomalies

The left coronary anlagen and bud fail to develop. To know, how and why this occurs ( Learn right here : Sharma B, Chang A, Crimson-Horse Ok. Coronary Artery Growth: Progenitor Cells and Differentiation Pathways. Annu Rev Physiol. 2017 )

Scientific implication of such coronary anomalies

Other than angiographic surprises, these anomalous coronary arteries might under-perfuse the ventricle and current as unexplained cardiomyopathy , till we understand the anatomical errors in coronary anatomy.

Some unanswered queries

1. Is the atresia confined to the ostium alone, or does it prolong to variable lengths of the left principal?

2. How do the fetal and subsequent neonatal LV mass outgrow RV , when the LCA is atretic?

Therapy of left principal atresia

Surgical procedure with graft makes logical correction. If completely asymptomatic, and the stress check is unfavourable, leaving it, as it’s, is just not a forbidden possibility, regardless of the actual fact, that the affected person would have a single coronary arterial provide.

Farhood Saremi Graydon Goodman , Alison Wilcox, J Am Coll Cardiol Img. 2011 Dec, 4 (12) 1320–1323

Acquired mimickers of left principal atresia

1. Syphilis

2. Aorto arteritis

3.Ostial Athero-sclerosis( Uncommon, however standing of different areas of coronary artery will normally reveal proof for atherosclerosis)

True affirmation, is feasible solely throughout surgical procedure , ie visulaing the absence of left coronary ostia.

Ultimate message

Coronary arterial anomaly is a much less mentioned subject these days, except & till, it intrudes an interventional heart specialist in his each day routine life, of delivering stents. In actuality, there might be 1000’s of asymptomatic ones within the public area. it may end up in each dangerous in addition to protecting occasions. One theoretical and real looking risk will be extrapolated. We all know, how hostile is the end result of Left principal STEMI. However, It may also be true in a number of fortunate souls, one of many above rings can open up immediately and alter the future.

Reference

1. Yassin AS, Dayco J, Kottam A. Left Predominant Coronary Artery Atresia: Diagnostic
   Photographs of a Uncommon Coronary Anomaly. Mayo Clin Proc 2023;98(5):655–656.
2. Musiani A, Cernigliaro C, Sansa M, Maselli D, De Gasperis C. Left principal
   coronary artery atresia: literature evaluate and therapeutical concerns.
   Eur J Cardiothorac Surg 1997;11(3):505–514.