Anomalous aortic origin of a coronary artery in 16,680 patients evaluated by cardiac computed tomography.

Abstract

Purpose: Anomalous aortic origin of a coronary artery (AAOCA) is a congenital cardiac anomaly in which a coronary artery arises from an abnormal location on the aorta. In this article, we refer to the classification by Cheezum et al. [1], which distinguishes anomalies according to the point of origin and the course of the abnormal artery. The study aimed to determine the frequency of occurrence of anomalies and to assess types associated with an increased risk of sudden cardiac death.

Methods: We retrospectively analyzed 16,680 electrocardiography-gated cardiac computed tomography (CT) scans from years 2015-2022. Anomalies were found in 102 patients. Inclusion criteria were: scan description allowing for identification of coronary anomalies or images available, and patient age over 18 years. This resulted in a sample of 96 patients with anomalies.

Results: The study group consisted of 42 women and 54 men; median age at the time of diagnosis was 61 years. The most common anomalies were: right anomalous origin of the left circumflex artery (R-LCx) (48 cases - 50%), right coronary artery from the left sinus (17 cases - 18%), left main coronary artery from the right sinus (7 cases - 7%), and left anterior descending artery from the right sinus (12 cases - 13%). The courses were as follows: retroaortic (47 cases - 48%), interarterial (27 cases - 29%), retrocardiac (2 cases - 2%), and prepulmonic (2 cases - 2%).

Conclusions: AAOCAs were found in 0.58% of CT scans performed. R-LCx was the most prevalent type, and the most prevalent course was retroaortic (47). Anomalies were mostly benign in their clinical manifestations.