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).