Role of MDCT coronary angiography in the evaluation of septal vs interarterial course of anomalous left coronary arteries
Received 12 January 2010; accepted 1 April 2010. published online 12 April 2010.
Background
Conventional coronary angiography (CCA) may be inaccurate to distinguish between interarterial and septal subtypes of anomalous left coronary arteries (CAs).
Objective
We compared the classification of anomalous left CA arising from the right sinus of Valsalva (RSV) or right CA on the basis of multidetector computed tomography coronary angiography (MDCTCA) with the classification derived from CCA.
Methods
A retrospective review of 6000 consecutive electrocardiographic-gated MDCTCAs identified 15 cases of anomalous left main or left anterior descending CA arising from the RSV or right CA coursing between the aorta and the main pulmonary artery. On the basis of MDCTCA findings, the proximal course of each vessel was classified into 3 subtypes: 1, interarterial; 2, septal; and 3, mixed. CCA was reviewed in 5 cases (33%) and classified according to traditional criteria. When CCA images were not available, 3-dimensional volume-rendered reconstructions were used to simulate CCA.
Results
On the basis of MDCTCA, subtypes were distributed as type 1 (n = 2), type 2 (n = 4), and type 3 (n = 8). One case could not be classified into any of these subtypes and was classified as type 4, right ventricular infundibulum (RVI). Applying CCA criteria, 2 cases would have been classified as interarterial and 14 as septal without appreciation of the mixed or RVI subtypes.
Conclusions
Classification of anomalous left CAs into either septal or interarterial may be too simplistic. There is an anatomic spectrum of anomalous left CAs detected by MDCTCA that challenges the traditional classification based on CCA.
aDepartment of Medical Imaging, Division of Cardiothoracic Imaging, Toronto General Hospital, University of Toronto, University Health Network, Mount Sinai Hospital, 585 University Avenue, Toronto, ON, Canada M5G 2N2
bDepartment of Diagnostic Imaging, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada
cDivision Of Cardiology, Toronto General Hospital; University of Toronto, University Health Network, Mount Sinai Hospital, Toronto, ON, Canada
Corresponding author.
Conflict of interest: Dr. Narinder Paul has received research support from Toshiba Medical Systems. The remaining authors report no conflicts of interest.
ABSTRACT