Pathophysiology
Clinical meaning
Coronary artery anomalies (CAAs) encompass a heterogeneous group of congenital variations in the origin, course, or termination of the coronary arteries that deviate from the normal coronary anatomy. Normal coronary anatomy consists of two coronary arteries arising from the aortic sinuses of Valsalva: the left main coronary artery (LMCA) originates from the left aortic sinus and bifurcates into the left anterior descending artery (LAD) and the left circumflex artery (LCx), while the right coronary artery (RCA) originates from the right aortic sinus. Coronary anomalies are found in approximately 1-2% of the general population on angiographic studies and 0.3% on autopsy series, though the true incidence varies depending on the definition and detection method used. The clinical significance of CAAs ranges from completely benign incidental findings to potentially lethal conditions. The most hemodynamically significant and dangerous anomaly is the anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS), particularly when the anomalous vessel takes an interarterial course (passing between the aorta and pulmonary artery). The two most clinically important variants are: (1) anomalous left coronary artery from...