None atherosclerotic coronary anomalies as detected by 64 multidetector computed tomography in patients with typical angina chest pain

الملخص EN

Background : The prevalence of none atherosclerotic coronary artery anomalies is low in the general population, although the spectrum of their clinical manifestations is very broad from total inequity to lethal events.

They are the worst cause of death in young adults.

Multidetector computed tomography (MDCT) is likely to be highly suitable none invasive test for detecting anomalies of coronary arteries.

Objectives : To report the prevalence and pathophysiology of coronary artery anomalies based on the capabilities of MDCT to provide an accurate noninvasive diagnostic approach.

Subjects and Methods : The study involved 1000 consecutive patients referred for MDCT due to typical angina chest pain.

Images were acquired using a Toshiba Aquilion 64 MDCT scanner and processed with Vitrea work station.

Results : None atherosclerotic causes of angina occurred in 65 patients (6.5 %).

The mean age was significantly lower in subjects with none atherosclerotic anomalies (48.5 + 3.4 vs.60 + 4.5 p 0.001).

Myocardial bridging was the most common (26 pts, 2.6 %).

20 pts (2 %) have ectatic aneurysmal dilated vessels.

13 pts (1.3 %) have Congenital abnormal origin of the coronary arteries (5 RCA arises from left coronary cusp, 2 left main coronary artery arises from right coronary cusp, 3 left circumflex arteries arise from RCA, and 3 left circumflex arteries arise separately form left coronary cusp.

4 pts (0.4 %) have coronary artery dissection (3 due to dissecting aortic flap, and one due to spontaneous coronary dissection.

2 pts (0.2 %) have arterio-venous fistulae.

One between posterior descending artery and middle cardiac vein, the second between LAD and main pulmonary artery.

100 % diagnostic accuracy confirmed by 64 MDCT and cine angiography in 29 subjects with none atherosclerotic Coronary anomalies.

Conclusion : None atherosclerotic Coronary artery anomalies are not uncommon among younger adults with typical angina chest pain.

Myocardial bridging was the most common.

MDCT is the first rank none invasive diagnostic tool to rule out such abnormalities.