Coronary Anomalies
2003; Lippincott Williams & Wilkins; Volume: 107; Issue: 5 Linguagem: Inglês
10.1161/01.cir.0000053949.60461.89
ISSN1524-4539
AutoresRoberto Barriales‐Villa, Juan C. Arias, César Morı́s,
Tópico(s)Cardiovascular Issues in Pregnancy
ResumoHomeCirculationVol. 107, No. 5Coronary Anomalies Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBCoronary Anomalies Roberto Barriales-Villa, MD, FESC and Juan C. Arias, MD César Morís, MD, FESC Roberto Barriales-VillaRoberto Barriales-Villa Cardiology Service, Complexo Hospitalario de Pontevedra, Mourente, Montecelo, Galicia, Spain and Juan C. AriasJuan C. Arias Cardiology Service, Complexo Hospitalario de Pontevedra, Mourente, Montecelo, Galicia, Spain César MorísCésar Morís Cardiology Service, Hospital Central de Asturias, Asturias, Spain Originally published11 Feb 2003https://doi.org/10.1161/01.CIR.0000053949.60461.89Circulation. 2003;107:e36To the Editor:We totally agree with the ideas expressed by Angelini et al1 in their article, but we would like to make some comments. With respect to noninvasive diagnostic methods and screening, we agree that MRI and electron-beam computed tomography are the ideal methods to be used for diagnostic purposes. In hospitals where these facilities do not exist, however, helical computed tomography with endovenous contrast can help identify the initial course of some coronary anomalies and their relations to the aorta and pulmonary artery.2The authors also mention that in the coronary angiograms of patients with suspected coronary disease, the coronary anomalies were more frequent in women than in men (7.6% versus 4.8%). We have reviewed 13 500 coronary angiograms from 9315 men and 4185 women and found 54 men and 21 women with coronary anomalies. We did not find significant differences (0.5% versus 0.5%).3 More studies are needed to confirm this.In the international literature published on this subject, considerable variation exists in relation to the incidence of coronary anomalies. This is due in part to the type of study included in the series. Thus, autopsy studies usually present higher incidences (2.2%)4 than those of angiographic studies (0.5%,3 0.64%5). However, we believe that this variability results from difficulty in finding 2 series that study exactly the same coronary anomalies. We also completely agree with Dr Angelini and his colleagues that international registers should be established that allow us to compare the different anomalies and thus reach a greater knowledge of them.1 Angelini P, Velasco JA, Flamm S. Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation. 2002; 105: 2449–2454.LinkGoogle Scholar2 Barriales-Villa R, Morís C. Usefulness of helical computed tomography in the diagnosis of the initial course of coronary anomalies. Am J Cardiol. 2001; 88: 719.Google Scholar3 Barriales-Villa R, Morís C, López-Muñiz A, et al. Anomalías congénitas de las arterias coronarias descritas en 31 años de estudios coronariográficos en el Principado de Asturias: características angiográficas y clínicas. Rev Esp Cardiol. 2001; 54: 269–281.CrossrefMedlineGoogle Scholar4 Frescura C, Basso C, Thiene G, et al. Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol. 1998; 29: 689–695.CrossrefMedlineGoogle Scholar5 Kimbiris D, Iskandrian AS, Segal BL, et al. Anomalous aortic origin of coronary arteries. Circulation. 1978; 58: 606–615.CrossrefMedlineGoogle ScholarcirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinsResponseAngelini Paolo, , MD, Velasco Jose Antonio, , MD, and Flamm Scott, , MD11022003We agree with the comments by Barriales-Villa and collaborators on our article1 and the near equivalence of helical computed tomography with magnetic resonance or electron beam tomography for some coronary anomalies.Regarding the incidence of coronary artery anomalies, the authors suggest that, in their own institutional experience, women have the same chance of anomalies as men, or 0.5% in a continuous series of 13 500 coronary angiograms. We reported2 a much larger incidence in women as compared with men, as well as a significantly higher incidence of coronary anomalies (5.6%) in both sexes in a catheterization laboratory population. The (recurrent) inconsistency is easily explained by the different methods of the analyses: A lower incidence is observed by authors reporting only "major anomalies" or "significant anomalies." We adopted the prospective utilization of a method of study (with clearly stated inclusion and exclusion criteria) and of a clearly stated classification chart based on strict definition criteria. The most frequent anomaly we found, for example, is "split right coronary artery," a typical anomaly disregarded by the majority of observers reporting on the subject. Similar examples, such as "small" coronary fistulae or muscular bridges, are often reported as occurring more frequently than in routine reports when ad hoc methods are used to carry out angiographic studies and analyses.2 Recently, most investigators have come to conclude that, of all coronary anomalies, one group (anomalous origin of a coronary artery from the opposite sinus of Valsalva) is responsible for most sudden deaths due to coronary anomalies in age groups older than infancy. Such subgroup incidence is important to recognize, and the literature contains a variety of data (from 0.1% to 2.05%), likely due to variable populations studied and diagnostic methods used.2 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Barriales-Villa R and Morís de la Tassa C (2006) Congenital Coronary Artery Anomalies With Origin in the Contralateral Sinus of Valsalva: Which Approach Should We Take?, Revista Española de Cardiología (English Edition), 10.1016/S1885-5857(06)60773-1, 59:4, (360-370), Online publication date: 1-Apr-2006. Barriales-Villa R and de la Tassa C (2006) Anomalías congénitas de las arterias coronarias con origen en el seno de Valsalva contralateral: ¿qué actitud se debe seguir?, Revista Española de Cardiología, 10.1157/13087058, 59:4, (360-370), Online publication date: 1-Apr-2006. February 11, 2003Vol 107, Issue 5 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000053949.60461.89PMID: 12578888 Originally publishedFebruary 11, 2003 PDF download Advertisement
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