X-ray angiography and magnetic resonance imaging to distinguish interarterial from septal courses of anomalous left coronary artery: an ex vivo heart model.
OBJECTIVE
We sought to demonstrate the distinguishing features between interarterial and intraseptal courses of an anomalous left coronary artery from the right sinus of Valsalva (RSV) on X-ray angiography, using an ex vivo model.


BACKGROUND
An anomalous left main coronary artery (LMCA) arising from the RSV can take prepulmonary, retro-aortic, interarterial (IA) or intraseptal (IS) courses, of which only the IA course is associated with sudden death. Anomalous LMCA is usually identified during catheter angiography. On Xray angiography, IA and IS courses have common characteristics that makes their distinction challenging. We hypothesized that the cranialcaudal orientation of the vessel on X-ray angiography allows these pathways to be distinguished, and tested this hypothesis using an ex vivo heart model.


METHODS
Plastic tubing was inserted along the IA and IS courses in an ex vivo normal pig heart. X-ray imaging in standard views and MRI on a 3-T scanner were performed.


RESULTS
In a normally formed heart, an anomalous LMCA with IA path must take a cephalad course, superior to the pulmonary valve. Conversely, an IS vessel will pass caudally, at or below the level of the infundibular septum. These findings were demonstrated in the X-ray angiograms and confirmed by magnetic resonance imaging.


CONCLUSIONS
X-ray angiography can differentiate IA and IS courses of an anomalous LMCA in the normally formed heart. This may obviate the need for further cross-sectional imaging in many cases.
Desai
Ravi V
RV
Department of Medicine, University of Alabama at Birmingham, 35294, USA.
Gupta
Ritesh
R
Litovsky
Silvio H
SH
Nath
Hrudaya
H
Gupta
Himanshu
H
Singh
Satinder P
SP
Evanochko
William T
WT
Knobloch
Johnnie E
JE
Lloyd
Steven G
SG
D000818:Animals; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging* / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology*; D006346:Heart Septum / Q000000981:diagnostic imaging* / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D023421:Models, Animal; D013552:Swine