Imaging of common coronary artery anomalies and imaging features important for clinical decision-making

Anomalous coronary arteries are associated with sudden cardiac death, although only in a relatively small percentage. Although this has been a field of study for years and there are many ongoing studies of larger patient cohorts and longer term follow-up, important questions remain at present in clinical decision-making, particularly whether or not to have surgery. Advanced imaging techniques including coronary computed tomography (CT) and cardiac magnetic resonance (MR) play an important role in the workup of patients with known or suspected anomalies including delineating origin and course as well as defining presence of high-risk imaging features. Multidisciplinary decision-making is important when considering whether patients might need to undergo surgery. This review will describe types of anomalies, imaging techniques, and features as well as types of surgeries and postoperative imaging with highlights of imaging and surgical literature and several case examples.