IDENTIFICATION OF ANOMALOUS CORONARY-ARTERIES AND THEIR ANATOMIC COURSE BY MAGNETIC-RESONANCE CORONARY ANGIOGRAPHY

Background Anomalous coronary arteries are a rare but recognized cause of myocardial ischemia and sudden death. Identification currently req uires x-ray angiography, which may have difficulty defining the three- dimensional course of the anomalous vessel. Magnetic resonance coronar y angiography (MRCA) has been shown to image coronary artery anatomy n oninvasively. We hypothesize that MRCA may be useful in the identifica tion of anomalous coronary arteries and their anatomic course. Methods and Results Sixteen patients (9 men, 7 women, age 44 to 81 years) wit h anomalous aortic origins of the coronary arteries by conventional x- ray angiography underwent MRCA. Multiple images of the major epicardia l coronary arteries were obtained by use of a breathhold, fat-suppress ed, segmented-k space, gradient-echo technique by investigators blinde d to all patient data. Anomalous coronary artery pathology, by x-ray a ngiography, included right-sided left main coronary artery (n=3), righ t-sided left circumflex artery (n=6), separate left-sided left anterio r descending and left circumflex arteries (n=2), left-sided right coro nary artery (n=4), and an anteriorly displaced right coronary artery ( n=1). MRCA correctly identified the anomalous coronary vessel(s) in 14 of 15 patients. In 1 patient, the anomalous vessel was incorrectly id entified, and in 2 patients the course of the anomalous vessel was not clearly seen; one of these was a nondominant, anomalous right coronar y artery. Conclusions MRCA is a useful technique for the noninvasive i dentification of anomalous coronary arteries and their anatomic course .