Congenital Coronary Anomalies: Clinical Presentation, Diagnosis and Current Management

Congenital coronary anomalies are rare but an interesting group of cardiac defects. Patient may present with ischemic chest pain, syncope or cardiac arrest or be completely asymptomatic.

Due to rarity of these defects, high index of suspicion is necessary. With significant advancements in coronary imaging, there is increased identification of these anomalies. Most defects require surgical correction but some, such as coronary artery fistula, can be treated in the cardiac catheterization lab. Despite advancements in diagnosis, there continues to be controversy in management of certain subtypes, specifically with anomalous aortic origin of coronary arteries, its management and long term outcomes. Risk of sudden cardiac death in asymptomatic/ borderline symptomatic patients is still not fully understood.

Congenital coronary anomalies are a rare but interesting group of defects. Management of these defects have significantly evolved with improvements in cardiac imaging, cath lab technology and surgical techniques. However there is a subset of defects (anomalous aortic origin of coronary arteries) where there continues to be significant controversy in management.