MSCT-64 0 IN DIAGNOSIS OF

CORONARY ANOMALIES OF

ORIGIN & COURSE

NGUYEN TUAN VU, MD, PhD

PNT UNIVERSITY

MEDIC HCM

BACKGROUNDMSCT Assessment of coronary stenosis

Congenital coronary anomalies are rare with an incidence ranging from 0.17% in autopsy cases to 1,2% in angiographycally evaluated cases.

Theses anomalies result in severe cardiovascular events & sudden death.

Some previous studies in Vietnam:

Tung Duy Le (2014 ):164 pts, MSCT-64 and DSA

Nhân Nguyen Thanh Vo (2016 ): 510 pts, MSCT-640

Phat Trieu Lam ( 2019 ): case report of RCA rising from LSV

End-Points of Study

Prevalence and characteristics of coronary artery anomalies in an population undergoing multi-detector row computed tomography.

Usefulness and limitation of MSCT in diagnosis of Coronary Anomalies of Origin& courses.

MATERIALS AND METHODSRetrospective study

Patients with cardiac imaging by MSCT-64 in MEDIC HCMC since 10/2006 , MSCT-640 since 05/2013

Instrument:TOSHIBA MSCT-640 Aquilion One

Metoprolol 50-200mg 1h prior to scan

0.5-1mm slice thickness

CE: Ultravist IV 1ml/kg

Wash out technique, single breath-hold.

Gantry rotation: 0,35sec

Volume rendering & Curved 2 D

Compare with DSA or operative results.

Basic Principles of Computed Tomography

From Pim J de Feyter ( 2005 )

Spiral CT & MSCT

From U. Joseph Schoepf ( 2005 ),

Results& Discussion

The study included: 9572 patients

Mean age= 63± 8.4, M / F=1.8

Coronary anomalies were detected

incidentally in most cases.

One young pt presented by cardiac arrest.

MSCT revealed LMCA originating from

RSV with intra-arterial course of LMCA.

The anomalous origins of Circumflex

Artery from the RCA or the right sinus of

Valsalva are most frequently.

Type of Anomalies n Prevalence

Cx originating fr. RCA/RSV 15 31.9%

0.16%

High taking off of RCA 11 23,4%

0.11%

RCA rising from LSV 8 17%

0.084%

LCA rising from the RSV 5 10.6%

0.052%

RCA arising from LAD 2 4.2%

0.021%

Absent RCA 2 4.2%

0.021%

Single coronary artery fr. LSV 1 2.1%

0.01%

ALCAPA 2 4.2%

0.021%

RCAPA 1 2.1%

0.01%

Anomalous types of origin and course

of the Left Main Coronary Artery

LMCA arising from RSV with

intra-arterial course.

LMCA arising from Left Sinus of Valsalva( Intra-Arterial course of LMCA )

Casr Report

A young male pt, 25 y.o , Long An province

Presented by chest pain, dyspnea, syncope then

cardiac arrest ( successful CPR )

No risk factors of CAD in past history

Previous diagnosis: primary dilated cardiomyopathy.

Pt underwent MSCT-640 coronary angiography to

rule out coronary artery disease.

Sinus rythm, QS in V1,V2

ST depression V4-V6

ECG

Chest X ray: normal

Echocardiography

Dilated LV, Akinesia of IVS, EF=35%

MSCT Coronary Angiography

Curved 2D Images

LAD KHÔNG HẸP

LMCA

LAD

CX

RCA KHÔNG HẸP

LCX KHÔNG HẸP

RCA

LM

Cx

LAD

Anomalous origin and course of LMCA.

PA

AO

ĐMV trái chính bị kẹp giữa 2 đại động mạch

LMCA originating from RSV

Gập gócAO

RVOT

Treatment and sequence

CABG to LAD and LCx

Post-op. was favourable

Single Coronary Artery

Bn nữ, 52 tuổi, đến khám vì đau ngực không điển hình

Thân chung ĐMV duy nhất xuất phát từ xoang Valsalva trái

Tác giả Prashanth Panduranga (2016 ) cũng mô tả một ca ĐMV độc nhất từ

xoang Valsalva phải đi khám vì đau ngực khi gắng sức.

Dị dạng này chiếm 0,024% đưa đến Đau TN, Đột tử, Đau ngực không điển

hình dù không tìm thấy chứng cứ tmct trên DSA và tử thiết.

Anomalies of origin and course

of RCA

High taking off RCA

High taking off of RCA, some time causes myocardial

infarction due to excessive angulation between RCA and

Aorta. We have in our study one young patient of 24 y.o that

had been transferred to the hospital by cardiac arrest , related

to this anomaly. Operative re-implanted had been indicated to

save the patient.

INTRA ARTERIAL COURSE OF RCA

RCA arising from LSV

RCA rising from LSand Intra-arterial course of RCA

LCx originating from RSV( Retro Aortic Course of LCx )

LCA ARISES FROM PA

( Anomalous Origin of Left Coronary Artery from

Pulmonary Artery )

PA LAD

LM PALCA

RCAPAAnomalous Origin of the Right Coronary Artery off The

Pulmonary Artery.

RCA

PAAO

Case reportA male pt of 50 y.o, presented by chest pain over 30mn

ECG Blood test

MSCT coronary angiography

LM& LAD LCX

No coronary stenosis detected

RCA RAMUS INTERMEDIUS

3D MSCT-Angiography

Myocardial Bridge

Anomalous intramural courses

CONCLUSION

Coronary anomalies of origin and course are rare, the

exact incidence of these anomalies in population are

unknown currently.

Most patients with these anomalies are asymptomatic,

the early detection of coronary anomalies of origin and

course are highly important.

Anomalous origin from opposite Valsalva sinus usually

cause severe cardiac events and sudden death.

Contrast enhanced ECG-gated 640-row MDCT coronary

angiography is an accurate diagnostic method that can

precisely detect the coronary anomalies of origin and

course.

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