Congenital heart disease CONGENITAL ANOMALIES OF THE CORONARY ARTERIES

Correspondence to: Dr Michael Hauser, Deutsches Herzzentrum Munich, Klinik für Kinderkardiologie und angeborene Herzfehler, Lazarettstraße 36, 80636 Munich, Germany; hauser@ dhm.mhn.de _________________________ N ormal coronary artery anatomy is characterised by two ostia centrally placed in the right and left sinus of Valsalva. The main left coronary artery (LCA) originates from the left ostium, branching into the left anterior descending artery and circumflex artery, which courses around the left atrioventricular groove; the right coronary artery (RCA) arises from the right ostium, providing an infundibular branch to the anterior side of the heart, and then courses backward in the atrioventricular groove. The three main coronary arteries branch superiorly to the atria and inferiorly to the ventricles; they end in broom-like arborisations, which penetrate the myocardium. Because of ventricular contraction myocardial perfusion of the left ventricle occurs mainly in diastole, while the myocardium of the right ventricle is perfused during both heart cycles. Clinical suspicion that a patient’s problems may be the result of coronary anomalies remains an important challenge in diagnosis, especially in children. Haemodynamically significant congenital anomalies of coronary arteries occur as isolated or primary forms and as secondary forms in association with congenital heart disease (CHD) (pulmonary atresia with intact interventricular septum or hypoplastic left heart syndrome with aortic atresia and severe mitral stenosis) (table 1). In this article only isolated/primary forms will be discussed.