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E1184. Case-Based Imaging Review of Anomalous Origin of Coronary Artery: “Unroofing” the Enigma
Authors
  1. Harkanwar Gill; University of Oklahoma Health Sciences Center
  2. Natalie Shahbazi ; University of Oklahoma Health Sciences Center
  3. Harold Burkhart; The Children's Hospital ; University of Oklahoma Health Sciences Center
  4. Charles Lawrence ; The Children's Hospital ; University of Oklahoma Health Sciences Center
Background
Coronary artery abnormalities (CAA) are uncommon findings in children that can have profound clinical implications. Actual prevalence of anomalous coronary artery from the opposite sinus (ACAOS) is difficult to determine, given the differences in identifying the population at risk. In the United States, coronary artery anomalies are the second most common cause of sudden cardiac death (SCD) in adolescents and young adults accounting for 17% of SCDs (1,2). The incidence of CAAs are reported at 0.78%–1.3% in invasive angiographic studies and 0.99%–5.8% in coronary computed tomographic (CT) angiographic studies (3).With recent advances in coronary imaging and increased utilization of computed tomography, magnetic resonance imaging (MRI) and intravascular ultrasound, we have been provided with enormous information on this subject, thereby garnering greater interest from radiologists, cardiologists and surgeons. The aim of this article is to review coronary CT angiography on commonly encountered CAAs in an attempt to familiarize the reader with normal anatomy, clinically relevant anomalies, as well as discuss post-operative images of affected patients.

Educational Goals / Teaching Points
Understand the imaging features of the anomalous origin of coronary arteries arising from the opposite sinus or improper “non-coronary” sinus that requires intervention. Understand the surgical technique of coronary unroofing. Discuss expected postoperative appearance. Anomalous coronary artery from the opposite sinus.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Review of standardized myocardial segments/nomenclature. Relevant normal cardiac anatomy on CT angiography. Variations/anomalies of coronary artery origin and course. Appearance of the coronary arteries on CT angiography after surgical unroofing procedure.

Conclusion
Anomalous aortic origin of a coronary artery has been associated with myocardial ischemia and sudden death. An interarterial course, particularly when associated with an intramural segment, is the abnormality most consistently associated with SCD. Surgery is the mainstay of treatment, though beta blockers and calcium channel blockers have been utilized to lessen ischemic symptoms. With advances in noninvasive coronary CT angiography, we have been provided with comprehensive anatomic evaluation of these rare entities.