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Incidence and treatment of congenital coronary artery anomalies.

BACKGROUND
Congenital coronary arteries anomalies are a rare entity. Although their identification started in the 60th, there is a lack of data concerning their frequency and clinical significance in Tunisia.


AIM
To characterize clinical and imaging features and mid-term follow up data of congenital coronary artery anomalies in a population of Tunisian adults.


METHODS
We reviewed the records of 6358 adult patients who underwent coronary angiography between 2009-2015 years in Mongi Slim hospital La Marsa, Tunisia. Multidetector computed tomography was performed on all patients diagnosed having these anomalies and Angelini classification was used for their arrangement. Patients, having intramural coronary artery, were excluded from this study.


RESULTS
Thirteen patients had congenital coronary arteries anomalies (seven females and six males). Ten had anomalies of origination and course while the others had anomalies of coronary termination. The right coronary artery was the vessel involved most frequently. It originated from an anomalous coronary ostium in four patients and a unique right coronary artery was reported in one case. An anomalous left main coronary artery was seen in four cases. One patient had the left anterior descending artery originating from the right Valsalva sinus. Four patients underwent coronary revascularization, one died before the intervention and the remainder received medical management. The mean follow up was 54.1±20 months.


CONCLUSION
Congenital coronary arteries anomalies have a low incidence in adults. Coronary revascularization is actually indicated in anomalous aortic origin with inter aorto-pulmonary course.