Figure 1
Normal anatomical origination of coronary arteries. Right coronary artery (CD) origination from the right coronary sinus travelling in the right atrioventricular groove, and origination of the left coronary trunk (TCE) from the left coronary sinus, bifurcating into descending anterior coronary artery (DA), travelling in the anterior interventricular groove, and circumflex artery (CX) travelling in the left atrioventricular groove. TP, pulmonary arterial trunk; VE, left ventricle; AE, left atrium; AD, right atrium; Ao Asc, ascending aorta.
Figure 2
Anomalous origination of left coronary artery. 2A: Anomalous origination of circumflex artery (CX) from the right coronary sinus, with retroaortic course (benign course). 2B: Anomalous origination of anterior descending artery (DA) from the right coronary sinus with interarterial course (malignant course). 2C: Anomalous origination of the anterior descending artery (DA) from the right coronary sinus, travelling anteriorly to the pulmonary arterial trunk (TP) (benign course). 2D: Anomalous origination of anterior descending artery (DA) from the right coronary artery, with transseptal course (benign course). 2E: Anomalous origination of the left coronary trunk (TCE) from the right coronary sinus, with retroaortic course (benign course). 2F: Anomalous origination of the left coronary trunk (TCE) from the right coronary sinus, with interarterial course (malignant course). 2G: Anomalous origination of the left coronary trunk (TCE) from the pulmonary arterial trunk (TP), called ALCAPA (anomalous left coronary artery from the pulmonary artery). CD, right coronary artery; VE, left ventricle; AE, left atrium; AD, right atrium; Ao Asc, ascending aorta.
Figure 3
Anomalous origination of right coronary artery. 3A: Anomalous origination of right coronary artery (CD) from the left coronary sinus, with retroaortic course (benign course). 3B: Anomalous origination of the right coronary artery (CD) from the left coronary sinus with interarterial course (malignant course). 3C: Anomalous origination of the right coronary artery (CD) from the pulmonary arterial trunk (TP). DA, Anterior descending artery; CX, circumflex artery; VE, left ventricle; AE, left atrium; AD, right atrium; Ao Asc, ascending aorta.
Figure 4
Single coronary trunk. 4A: Single coronary trunk (TCU) originating from the right coronary sinus. 4B: Single coronary trunk (TCU) originating from the left coronary sinus. CD, right coronary artery; TCE, left coronary trunk; DA, anterior descending artery; CX, circumflex artery; TP, pulmonary arterial trunk; VE, left ventricle; AE, left atrium; AD, right atrium; Ao Asc, ascending aorta.
Figure 5
Triple rule-out chest computed tomography angiography with oblique sagittal reconstruction demonstrating four possible proximal courses (pre-pulmonary, interarterial, retroaortic and transseptal) of a coronary artery with anomalous origination. AE, left atrium; VE, left ventricle; VD, right ventricle; TP, pulmonary artery trunk.
Figure 6
Absence of left coronary trunk. Axial coronary computed tomography angiography and MIP reconstruction showing the origination of the anterior descending artery (DA) and circumflex (CX) artery directly from the left coronary sinus. Ao Asc, ascending aorta.; CD, right coronary artery; AE, left atrium; TP, pulmonary artery trunk.
Figure 7
High origin of right coronary artery. Fig 7A: Axial computed tomography angiography with MIP showing high origin of right coronary artery (CD) from the aortic arch (Arco Ao). Fig 7B: Axial coronary computed tomography angiography with MIP showing right coronary sinus (SCD) without coronary artery originating from it. TP, pulmonary artery trunk; SCE, left coronary sinus; TCE, left coronary trunk.
Figure 8
Anomalous origination of right coronary artery from the left coronary sinus, with interarterial course. Fig 8A: Axial coronary computed tomography angiography with MIP showing anomalous origination of right coronary artery (CD) from the left coronary sinus (SCE), with interarterial course between the pulmonary artery trunk (TP) and the ascending aorta (Ao Asc) (malignant course). Fig 8B: Same patient from Fig 8A, coronal MIP image of right coronary artery (CD) showing a large diameter artery with important anatomic and functional meaning. Fig 8C: Axial coronary computed tomography angiography with MIP showing another patient with anomalous origination of right coronary artery (CD) from the left coronary sinus and interarterial course between the pulmonary artery trunk (TP), anteriorly, and ascending aorta (Ao ASC), posteriorly (malignant course). Fig 8D: Same patient from Fig 8C, coronal MIP image of right coronary artery (CD) showing a hypoplastic artery, without anatomic and functional meaning. CX, circumflex artery.
Figure 9
Anomalous origination of left coronary trunk from the right coronary sinus. Fig 9A: Benign course. Axial coronary computed tomography angiography with MIP showing anomalous origination of left coronary trunk (TCE) from the right coronary sinus (SCD), with retroaortic course between the ascending aorta (Ao Asc), anteriorly, and the left atrium (AE), posteriorly. Fig 9B: Malignant course. Axial coronary computed tomography angiography with MIP showing anomalous origination of the left coronary trunk (TCE) in the right coronary sinus (SCD), with interarterial course between the pulmonary artery trunk (TP), anteriorly, and the ascending aorta (Ao Asc), posteriorly. CD, right coronary artery; RC, conal branch; AE, left atrium.
Figure 10
Anomalous origination of the circumflex artery from the right coronary sinus, with benign course. Axial coronary computed tomography angiography with MIP showing anomalous origination of the circumflex artery (CX) from the right coronary sinus (SCD), with retroaortic course between the ascending aorta (Ao Asc), anteriorly, and the left atrium (AE), posteriorly. The right coronary artery (CD) and the anterior descending artery (DA) have normal origination from the right and left coronary sinuses, respectively.
Figure 11
Single coronary trunk. Fig 11A: Oblique axial coronary computed tomography angiography with MIP showing single, short coronary trunk (asterisk) with calcified atheromatous plaque, originating from the right coronary sinus and giving origin to the right coronary artery (CD) and the left coronary trunk (TCE), which bifurcates into the anterior descending artery (DA) and the circumflex artery (CX), both travelling anteriorly to the pulmonary arterial trunk (TP). Fig 11B: Invasive coronary angiography (catheterization) identifying the same anatomical division demonstrated at coronary computed tomography angiography.
Figure 12
Coronary fistula. Coronary computed tomography angiography – axial (Fig 11A), oblique coronal (Fig 11B), axial MIP (Fig 11C) and volumetric rendering demonstrating a tortuous coronary fistula (* Fis), communicating the anterior descending artery (DA) and the pulmonary artery trunk (TP).