Congenital Heart Disease

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Jan 4, 2019

Coronary Artery Anomalies

By Naser M. Ammash, MD, @naserammash

2018-01-04 CAA

Congenital Coronary Artery Anomalies can be of four types: Ectopic Coronary Artery Origin, Coronary Artery Aneurysm, Coronary Artery Fistulae, and the most common,  Coronary Artery Bridge.

As detailed by Mayo Clinic Adult Congenital Heart Disease expert Naser Ammash, M.D. in the video below, the majority of these anomalies are benign, but some such as ectopic coronary artery origin can be life threatening.

He shares that Coronary Artery Anomalies are the second or third most common cause of sudden death among athletes under 35 of age and less so among older individuals involved in recreational sports.  The most malignant congenital coronary artery anomaly usually involves  an Anomalous origin of left coronary artery from the opposing right coronary sinus or  from Pulmonary Artery. Dr. Ammash illustrates what that means, how it affects the heart, the potential reasons for symptoms and what treatment options are available.

Other, more common ectopic coronary artery anomalies explained by Dr. Ammash are usually benign but can be a concern depending on the course of the anomalous coronary artery such as when it runs between the aorta and pulmonary artery.

He shares with us the  details of a case involving  a 49-year-old with a coronary artery anomaly and describes how to assess such patient in regards to risk of sudden cardiac death, the role of stress testing, monitoring and imaging.

Dr. Ammash describes the very important role of CT scan imaging in the evaluation of these anomalies including the difference between intramural, extramural and intramyocardial courses of the ectopic coronary artery.

Furthermore, he notes the potential role of cardiac catheterization with intravascular coronary ultra-sound in the evaluation of a select group of these patients  as it allows direct assessment of the stenosis created by these anomalies which might help in the decision making regarding treatment.

Lastly, Dr. Ammash reviews the biggest takeaways from his explanation of Risk Stratification of Anomalous Coronary Arteries and shares important things to remember in regards to this condition and his recommendations on when to consider treatment.

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