Clinical & Experimental Cardiology
Open Access

Significance of Coronary Artery Anomalies

Carlo Pangotta^{* *}Correspondence: Carlo Pangotta, Department of Cardiology, IRCCS San Raffaele Scientific Institute, Milan, Italy, Email:

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Description

Currently, the characteristics of the (conductive) epicardial coronary tree and its dependent region mainly determine the coronary anatomy. As a result, it is important to take into account all the potential and actual changes in the anatomical features that are utilized to describe the coronary arteries. The right coronary artery, circumflex artery, and left anterior descending artery be regarded as the fundamental, basic units of coronary anatomy. Additionally, the intermediate and distal segments or the dependent microvascular bed serve as the defining characteristics of the coronary arteries rather than their origin or proximal course.

Before accurate information about the prevalence of coronary abnormalities can be acquired, a rigid classification system is required. Anomalies that only infrequently result in critically serious clinical events and are otherwise compatible with a normal existence provide the most challenge in terms of clinical relevance. In many situations, it is unknown if a certain anomaly's specific characteristics have negative clinical effects or if additional episodic elements are necessary. A sizable, multicenter database depending on prospective, coordinated methods is urgently required to correlate sub-classifiable morphological and functional parameters with clinical occurrences and prognoses. Realistic techniques can be used for identifying and treating cardiac abnormalities in the absence of formal recommendations.

In contemporary cardiology, coronary abnormalities are a poorly known subject. As a result of the anomalies' potential to cause sudden mortality, clinicians and members of the general public may be aware of them. The anatomic spectrum of coronary anomalies (which is frequently represented by a lengthy, incomplete list without a rationale), the pathophysiologic mechanisms at play, the clinical repercussions and prognoses of abnormal coronary anatomy, and other fundamental issues all need to be clarified. Treatment recommendations frequently lack support, are inconsistent, and are therefore unreliable because of how poorly these problems are understood. There is a need to analyze further cardiac anomaly identification and therapy by attempting to explain some of these concerns. One of the most perplexing and under explained topics in the medical literature is the steal phenomena connected to coronary artery fistulas. Theoretically, there are two different forms of steal phenomenon. The first form is chronic steal, which is brought on by the presence of big fistulous tracts that also feed nutritional branches or receive collateral vessels that come from the opposing coronary vessels.

A proximal fistulous artery that is somewhat constrictive can limit the flow of nutrients. When physiological conditions boost shunting flow into the fistula at the expense of nutritional flow, it results in episodic steal, the second type of steal phenomena. Persistent theft can, in the worst instance, result in continued ischemia at rest or a hibernating state that includes myocardial dysfunction (potentially reversible), resting angina, or both. Exercise and stress testing with vasodilators are likely to provide unfavorable results in cases of episodic theft because they increase flow more towards the nutritional branches than towards the fistulous tract (which has no discernible vasodilatory capacity). Results from nuclear stress tests are typically negative for reversible ischemia in clinical practice and frequently raise questions regarding the presence of scar tissue. The sheer existence of the extensive coronary network, which has the ability to displace the myocardium, might imply scarring. It will be crucial in the future to make use of more modern diagnostic methods like Intravascular Ultrasound (IVUS) and pressure-wire tests. Intimal integrity, mural clots, artery size, and localized aneurysms may all be assessed with IVUS, and pressure-wire tests can be utilized to determine the pressure loss along fistulous arteries.

Cardiologists require a larger database that can connect subclassifiable anatomic and functional traits with clinical occurrences and prognoses before they can provide evidencebased recommendations about therapies for cardiac abnormalities. To make such a database a reality, the independent work of several specialized centers, each of which depends on future coordinated protocols, will have to come together. This seems like a great idea for facilities that focus on treating congenital cardiac abnormalities in adults.