Coronary artery anomalies: assessment with free-breathing three-dimensional coronary MR angiography.
OBJECTIVE
To evaluate a simplified protocol by using free-breathing three-dimensional (3D) coronary magnetic resonance (MR) angiography to determine the anatomy of anomalous coronary arteries, in particular the relationship of the vessels to the aortic root.


METHODS
Twenty-six patients (18 men, eight women; mean age, 50 years; age range, 18-77 years) who had a history of chest pain, palpitations, or syncope and who were suspected of having coronary artery anomalies were examined with free-breathing MR angiography. Multiple 3D volume slabs were acquired at the level of the sinuses of Valsalva by using diaphragmatic navigators for respiratory artifact suppression. The proximal anatomy of the coronary arteries was determined.


RESULTS
Six anomalous circumflex arteries originated from the right sinus of Valsalva and passed behind the aortic root. Six right coronary arteries arose from the left sinus of Valsalva and coursed between the aortic root and the right ventricular outflow tract (RVOT). Nine left coronary arteries arose from the right sinus of Valsalva; seven of nine coursed between the aortic root and the RVOT. Five patients had minor anomalies. Overall, in eight patients with anomalous arteries that coursed between the aortic root and the RVOT, conventional coronary angiography could not be used confidently to identify the proximal course.


CONCLUSIONS
Free-breathing 3D coronary MR angiography can be used to identify the proximal anatomy of anomalous coronary arteries.
Bunce
Nicholas H
NH
CMR Unit, Royal Brompton Hospital, Sydney St, London SW3 6NP, England.
Lorenz
Christine H
CH
Keegan
Jennifer
J
Lesser
John
J
Reyes
Eliana M
EM
Firmin
David N
DN
Pennell
Dudley J
DJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D003330:Coronary Vessel Anomalies / Q000175:diagnosis*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012119:Respiration