CHAPTER Twenty-five CORONARY ARTERY ANOMALIES AND DISEASE
CHAPTER Twenty-five CORONARY ARTERY ANOMALIES AND DISEASE
Coronary Artery Anatomy Left Main Coronary Artery Left Anterior Descending Coronary Artery Left Circumflex Coronary Artery Ramus Intermedius Right Coronary Artery Posterior Descending Artery Posterior Lateral Branch Conus Branch Sinoatrial Nodal Branch Atrioventricular Nodal Branch
Coronary Artery Anomalies Abnormalities in Origin Abnormalities in Origin, Benign Abnormalities in Origin, Possibly Malignant Abnormalities in Course Myocardial Bridging Intracavitary Course Split (Double) Coronary Artery
Noninvasive imaging of the coronary arteries can be obtained through various modalities including ultrasound (echocardiography), CT, and MRI. While echocardiography is a useful tool to rapidly assess systolic and diastolic myocardial function and complications of myocardial infarct, its ability to directly assess the coronary arteries is limited. Due to its excellent spatial resolution as low as zero point five millimeters and temporal resolution as low as sixty-six milliseconds, cardiac CT has become the primary tool to directly visualize the anatomy as well as congenital and acquired anomalies of the coronary arteries. While cardiac MRI can be used to assess the coronary arteries, its strength lies in its ability to assess for myocardial damage after infarction and to guide therapy.
CORONARY ARTERY ANATOMY
CORONARY ARTERY ANATOMY
The coronary arteries course through the epicardial fat to supply oxygenated blood to the myocardium. Coronary artery anatomy is highly variable, and the size and distribution of the coronary arteries vary from person to person. Given this, it is important to distinguish normal variant anatomy from congenital abnormalities. It is also imperative to distinguish between benign congenital anomalies and ones that can compromise myocardial blood flow with subsequent myocardial ischemia, infarction, or sudden cardiac death.