Ectopic Origin of Coronary Arteries from Aorta. Clinical and Epidimiological Analysis

Adult Congenital Heart Unit, Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petach Tikva and Cardiac Institute, Sheba Medical Center, Sackler school of Medicine, Tel Aviv University.

Ectopic origin of a coronary artery from aorta is a relatively rare congenital heart anomaly. In many cases, it is an incidental finding on catheterization and of no clinical significance. In some cases, it may be the cause of sudden death.

We studied both the epidemiologic and clinically important aspects and present our conclusions, based on retrospective analysis of 3000 catheterizations in adults and evaluation of 10 clinical cases.

Based on retrospective analysis of coronary angiograms, that had been performed in adults for the evaluation of coronary atherosclerosis. 0.5% of patients had an ectopic left coronary artery from the right sinus, and 0.3% had a right coronary artery arising from the left sinus.

Analysis of pathology of the coronary arteries and clinical outcomes of the patients led to the conclusion, that the ectopic artery did not influence the clinical course or treatment strategies.

10 adult patients are being followed with clinically important lesions. 4 females and 6 males. Symptoms included chest pain-4 cases, dizziness- 5 cases, syncope -2 cases and palpitations -4 cases.

Evaluation included clinical examination, echocardiogram, ergometry in all cases, stress echocardiogram in 5 cases, MRI in 5 cases and catheterization in 5 cases. Four patients underwent successful surgical repair.and remain asymptomatic

In all 4 cases, the ectopic artery was the left coronary artery arising from the right sinus. There were no deaths in this series.

The pathological substrate for myocardial ischemia and the approach to treatment will be discussed.