Assessment of Anatomical Variation of Coronary Arteries for Sudanese Patients Using Cardiac Computed Tomography Angiography

Salem Saeed Alghamdi, Rowa Aljondi, Ikhlas Abdelaziz, Mohamed Yousef, Mustafa Z. Mahmoud, Mugtaba Elgazali, Abdulrahman Tajaldeen

 
International Journal of Biomedicine. 2020;10(2):101-103.
DOI: 10.21103/Article10(2)_OA1
Originally published June 15, 2020.

Abstract: 

Background: The aims of this study were to assess the prevalence of anatomical variation of coronary arteries among Sudanese patients using cardiac computed tomography angiography (CTA) and to identify the pathological finding for patients undergoing cardiac CTA.
Methods and Results: This prospective cohort study was conducted with 87 Sudanese patients subjected to cardiac CTA examination, using a 64-slice CT scanner (Aquillon 64, Toshiba Medical Systems, Tochigi, Japan) with retrospective ECG gating. Data were collected from 3D reconstruction at optimal phase. The numbers of diagonal and obtuse marginal branches were counted. The presence of ramus intermedius and origination of the right coronary artery (RCA) from right coronary sinus (RCS) were also reported.
Findings showed that most patients had one (33.3%) or two (47.1%) diagonal artery branches. In addition, 3.4% of patients had no diagonal branches, 12.6% had three and 3.4% had more than three diagonal branches arising from the left anterior descending artery (LAD). About 8% of our patients had no obtuse marginal branch. The majority of patients had one, two and three branches of the obtuse marginal arising from a left circumflex artery, which amounted to 24.1%, 41.4% and 25.3%, respectively. Only one patient had more than three obtuse marginal branches. Furthermore, 94.3% of patients presented with RCA originating from RCS, and 5.7% of patients had an ectopic origin of the left coronary artery (LCA).
Conclusion: This study concluded that there is a wide variation in the number of diagonal and obtuse marginal branches arising from the left circumflex artery among Sudanese patients. Ramus intermedius was the most common anatomical variation affecting the coronary artery. Ectopic origination of the RCA is a very rare condition in Sudanese patients.

Keywords: 
anatomical variation • coronary arteries • cardiac computed tomography angiography
References: 

1. Snell RS. Clinical anatomy by regions. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2011.
2. Germann WJ, Cindy L. Stanfield CL. Principles of human physiology. Har/Cdr ed. San Francisco: Benjamin Cummings; 2002.
3. Kelley LL, Petersen CM. Sectional anatomy for imaging professionals. 4th edition. Maryland Heights, Missouri: Mosby; 2018.
4. Durst R, Bogot N, Gilon D, Drenger B. Potential role for coronary computerized angiography for assessing preoperative ischemic risk. J Cardiothorac Vasc Anesth. 2010;24(2):348-55. doi: 10.1053/j.jvca.2009.12.007.
5. Sun Z, Ng KH. Multislice CT angiography in cardiac imaging. Part II: clinical applications in coronary artery disease. Singapore Med J. 2010;51(4):282-89.
6. Sun Z. Cardiac Imaging Modalities in the Diagnosis of Coronary Artery Disease. J Clin Exp Cardiolog. 2013;S6: 1-4. doi: 10.4172/2155-9880.S6-e001
7. Kitagawa K, Lardo AC, Lima JAC, George RT. Prospective ECG-gated 320 row detector computed tomography: implications for CT angiography and perfusion imaging. Int J Cardiovasc Imaging. 2009;25(2):201-8. doi: 10.1007/s10554-009-9433-6.
8. Romans L. Computed Tomography for Technologists: A comprehensive text. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2018.
9. Huxley RR, Barzi F, Lam TH, Czernichow S,  Fang X, Welborn T, et al.; Asia Pacific Cohort Studies Collaboration and the Obesity in Asia Collaboration. Isolated low levels of high-density lipoprotein cholesterol are associated with an increased risk of coronary heart disease: an individual participant data meta-analysis of 23 studies in the Asia-Pacific region. Circulation. 2011;124(19):2056-64. doi: 10.1161/CIRCULATIONAHA.111.028373.
10. Abdelrahman SF, Salem MA, Mostafa NDE, Elbohy AEM. Coronary arteries variants & congenital anomalies; using MDCT to assess their prevalence in 1000 of the Egyptian population. Egypt J Radiol Nucl Med. 2015;46(4):885-892. doi: 10.1016/j.ejrnm.2015.09.012.
11. Erol C, Koplay M, Paksoy Y. Evaluation of anatomy, variation and anomalies of the coronary arteries with coronary computed tomography angiography. Anatol J Cardiol. 2013;13(2):154-64. Doi: 10.5152/akd.2013.041.

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Received May 20, 2020.
Accepted June 10, 2020.
©2020 International Medical Research and Development Corporation.