Anomalous Coronary Artery

What is an anomalous coronary artery?

An anomalous coronary artery wasn’t formed correctly before birth. In many cases, the coronary artery is in the wrong place or is coming from the wrong place. This problem can affect:

• Right coronary artery.
• Left coronary artery.
• Left circumflex artery.
• Left anterior descending artery.

The problem with anomalous coronary arteries is that they aren’t where they’re supposed to be. They may start in:

• The wrong part of your aorta (most common).
• Part of a different coronary artery.
• Another artery.
• The pulmonary artery.

Types of coronary artery anomalies include:

A common coronary artery anomaly is an artery coming out of the wrong aortic sinus of Valsalva. Normally, the right coronary artery comes out of the right aortic sinus of Valsalva. Similarly, the left coronary artery comes out of the left aortic sinus of Valsalva.

A coronary artery that starts from the pulmonary artery instead of the aorta is another type of anomaly. This can affect the left or right coronary artery or (rarely) both. A rare form involves an accessory artery. In some cases, the normal coronary artery can make up for what the abnormal coronary artery can’t do. This is why some people don’t have symptoms until they become adults.

How common is anomalous coronary artery?

Up to 1% of the population has an anomalous coronary artery. Most cases are not dangerous.

How does anomalous coronary artery affect my body?

When one of your coronary arteries is in the wrong place, it disrupts the normal way blood flows through your heart. This can keep oxygen-rich blood from getting to your heart muscle.

What are the symptoms of anomalous coronary artery?

Anomalous coronary artery symptoms may differ based on the type of anomaly. Many children don’t have symptoms of anomalous aortic origin of a coronary artery (AAOCA) from opposite sinus of Valsalva. Sudden cardiac arrest or sudden cardiac death during exertion may be the first sign of it.

Anomalous aortic origin of a coronary artery (AAOCA) symptoms include:

• Chest pain with exercise.
• Fainting during exercise.
• Shortness of breath during exercise.
• Murmur.

Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) symptoms may show up at birth or between ages 40 to 60. Symptoms may include:

• Angina.
• Shortness of breath.
• Heart failure.
• Murmur.
• Sudden cardiac death.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) symptoms often show up in a baby’s first year. They include:

• Signs of pain or irritability.
• Crying while feeding.
• Acute coronary syndrome.
• Congestive heart failure.
• Murmur.

Children or adults with ALCAPA can have:

• Shortness of breath.
• Abnormal heart rhythm.
• Palpitations.
• Angina.
• Sudden cardiac arrest.
• Heart attack.
• Heart failure.

What causes anomalous coronary artery?

An anomalous coronary artery is a congenital problem, which means you were born with it. This rare heart problem happens to a baby during its first month or so in the womb when the coronary arteries form.

Diagnosis & Tests

How is anomalous coronary artery diagnosed?

Making an anomalous coronary artery diagnosis can be difficult because someone with the condition can have a normal physical exam. Also, some people don’t have symptoms.

What tests will be done to diagnose anomalous coronary artery?

Tests for anomalous coronary artery include:

• Computed tomography (CT) angiography.
• Echocardiogram.
• Electrocardiogram (EKG).
• Cardiac MRI.
• Stress test.

How is anomalous coronary artery treated?

Providers recommend surgery for certain people (with or without symptoms) with anomalous origin of the left coronary artery, but only for some of those who have anomalous origin of the right coronary artery with symptoms. Most adults with anomalous origin of the right coronary artery don’t need surgery.

If surgery isn’t a good option, your provider may recommend limiting your exercise and taking blood pressure medicines like diuretics or beta blockers. You won’t need to limit your exercise if your anomaly isn’t dangerous.

What medications/treatments are used?

Many people without symptoms, especially young and healthy people, choose to have surgery to prevent possible problems with their coronary arteries.

Surgeries for anomalous coronary artery include:

• Moving your artery and attaching it to your aorta or the correct sinus.
• Coronary unroofing (opening the top of a coronary artery coming from the wrong sinus).
• Pulmonary artery translocation (moving the pulmonary artery).
• Proximal coronary artery patch enlargement.
• Coronary artery bypass grafting.
• Percutaneous coronary intervention with stent placement.

Complications/side effects of the treatment

Surgery has a small risk of death. Complications include bleeding and blood clots.

How can I prevent anomalous coronary artery?

Unfortunately, you can’t prevent anomalous coronary artery because it’s a condition you have when you’re born.

What can I expect if I have anomalous coronary artery?

If you’ve had surgery to correct the problem, you can go back to sports activities three months after surgery. You can have a normal life, but will need to get regular medical checkups.

How long does anomalous coronary artery last?

Since anomalous coronary artery is a problem you’re born with, it will always be there unless you have surgery.

Outlook for anomalous coronary artery

If your baby has ALCAPA and doesn’t receive treatment, there’s a 90% chance it will be fatal. In a small number of cases, people grow to be adults with no symptoms or have symptoms as adults. The outlook is good if your provider treats ALCAPA before problems happen. However, there isn’t much information about long-term benefits of treating anomalous coronary arteries.

For AAOCA, surgical unroofing gets rid of symptoms and protects you from sudden death.

How do I take care of myself?

If you’re waiting to have surgery or if surgery isn’t a good option for you, your provider may ask you to limit your exercise. If you’re considered low risk, you may not need surgery and can exercise as much as you want.

When should I see my healthcare provider?

Contact your provider when your baby:

• Cries often.
• Is too pale.
• Is breathing too quickly.

For adults, see the list of symptoms.

When should I go to the ER?

You should go to the ER if you’re having chest pain.

What questions should I ask my doctor?

• Which type of anomalous coronary artery do I have?
• What is the best treatment for me?
• How often do I need checkups?

A note from Cleveland Clinic

While most people with an anomalous coronary artery aren’t in danger, the problem can be very dangerous for some. Sometimes people don’t have symptoms until they have a sudden cardiac arrest. Fortunately, several surgical options can protect you from sudden death and help you have a normal life. Be sure to keep taking any medicines your provider ordered and get regular checkups.