June 01, 2019
Sudden cardiac death (SCD), the swift, unanticipated loss of life due to undetected coronary abnormalities and anomalies, remains an Achilles' heel of contemporary medical practice. Within the field of cardiovascular medicine, insights have emerged in identifying conditions that may be associated with SCD, allowing for either early intervention or prophylactic measures.
Congenital coronary anomaly
3D volume-rendered images from computerized tomography angiography demonstrating a congenital coronary anomaly with the left anterior descending artery (LAD) arising from the main pulmonary artery (PA).
Congenital anomalies of the coronary arteries are purported to be relatively uncommon, but they contribute to the top three causes of SCD in those younger than 35 years of age. These abnormalities are clinically heterogeneous and may be simplified to those anomalies of origin, course or termination.
Within these broad groups are predefined subgroups that have characteristics considered to be associated with SCD. To date, these anomalies are generally discovered incidentally, either in asymptomatic individuals who undergo testing for unrelated conditions or in symptomatic individuals in whom a broad net of testing is undertaken. When anomalies of the coronary arteries are discovered unexpectedly, it must be determined whether they require intervention and, if so, what type of intervention is required.
Unfortunately, the extent to which the various coronary anomalies portend SCD is still debated and further conflict exists regarding the appropriate strategy of care. These issues are further complicated by the fact that research in the field is limited to small, retrospective observational studies that limit the understanding of these anomalies. Despite these hindrances, the general community of cardiologists agrees on a number of anomalies that require attention. The next intuitive step is to build centers of expertise that can serve as pillars of care, education and inquiry.
The Mayo Clinic Adult Congenital Heart Disease Clinic was originally established to serve those with congenital heart disease during an era when understanding of these complex lesions was evolving. Since its establishment, the clinic has grown to serve a wide number of individual patients from all over the globe. With the same mission statement to care for the sick and advance the science, a specialized subclinic devoted to the care and understanding of anomalies of the coronary arteries ― the coronary anomaly clinic ― is now established with integration of clinical cardiologists, cardiac imaging specialists and cardiovascular surgeons with a focused interest in the field.
For more information
Adult Congenital Heart Disease Clinic. Mayo Clinic.