Congenital and acquired coronary artery anomalies in newborns, infants, children, and young adults

The incidence of coronary anomalies in the general population is 0.2 % to 1.2 %. In this chapter, the comprehensive nomenclature classification of the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Nomenclature and Database Project will be used. Coronary artery anomalies may be congenital or acquired and are associated with significant morbidity and mortality. The spectrum of congenital lesions includes anomalous pulmonary origins of the coronary arteries, anomalous aortic origins of the coronary arteries, single coronary artery, congenital atresia of the left main coronary, coronary artery fistulas, and intramyocardial courses. Acquired anomalies include coronary artery aneurysms, late postoperative obstructions in patients who had coronary artery surgical manipulations, and iatrogenic injuries that can occur in the catheterization laboratory or in the operating room. In this chapter, the anomalies described are those in hearts with concordant atrioventricular and ventriculoarterial connections. Coronary variations in complex congenital heart diseases are not encompassed, nor are coronary artery lesions that are associated with initial operations for arterial switch, tetralogy of Fallot repair, and the various types of Norwood operations.