Symptom of presentation and anatomic characteristics
Symptom of presentation were chest pain in 14/25 patients (56%). In all
patients the chest pain was referred with the specific features of the
cardiac chest pain (central in the chest and oppressive). Three patients
(12%) were referred for ventricular arrhythmia, two patients (8%) were
referred for non-specific cardio-vascular symptoms (dyspnea and
dizziness). Six patients (24%) were asymptomatic and AAOCA was
discovered during investigation for competitive sport. No episodes of
sudden cardiac death were reported in our population. No statistical
differences were found between AAORCA and AAOLCA for presence and type
of symptoms of presentation (p =.09).
In hospital preoperative standard electrocardiographic investigation did
not revealed ischemic alterations in all but ventricular arrhythmia was
detected in three (12%). At routine preoperative echocardiographic
investigation, two patients, both with AAORCA (8%) showed localized
right basal hypokinesia.
Preoperative functional studies (treadmill test or nuclear perfusion
scintigraphy) were made in 10/25 patients (40%). Five of them (20%),
showed ischemic signs (two with AAORCA and three with AAOLCA, P = .17).
Computed tomography scan revealed the following anatomic
characteristics: in the group of AAORCA, 15 (60%) patients had an
inter-arterial and intra-mural course, while 4 (16%) had only
inter-arterial course and right dominant coronary circulation. In the
group AAOLCA, three (12%) patients had inter-arterial but no intramural
course, two (8%) inter-arterial plus intra-mural course and one (4%)
intra-mural course alone. In all but one cases the anomalous coronary
artery originated from the opposite sinus (right coronary artery from
left sinus and vice-versa ) except for a case of AAOLCA in which
the left coronary artery originated from non-coronary sinus and had
intra-mural course. Median length of intramural segment was 8 mm (min 3
mm - max 11 mm).