日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Coronary artery anomalies are not uncommon, occurring in 1.3％ of the overall population. Most patients are asymptomatic, and the condition is found incidentally. However, these patients are potentially at a high risk for life-threatening complications. The left coronary artery originating from the right Valsalva sinus with an interarterial course is known to be a cause of sudden death in young athletes and should be surgically repaired even if the patient is asymptomatic. Exercise electrocardiography in this anomaly is not reliable, and a coronary imaging test, such as echocardiography, computed tomography angiography, or coronary arteriography, is needed when this anomaly is suspected. The anomalous origin of the left coronary artery may cause severe myocardial ischemia, left ventricular dysfunction, and mitral regurgitation in early infancy. Early surgery is indicated to establish a two-artery coronary system. Coronary arteriovenous fistula may cause myocardial ischemia and heart failure, and the indication for surgery is based on clinical symptoms. Preoperative coronary imaging is important in both catheter occlusion and surgical occlusion. Coronary artery anomalies should be included in the differential diagnosis of cardiac symptoms, such as angina, myocardial ischemia, arrhythmia, and heart failure.