Coronary artery birth defects, epidemiological and clinical features: A retrospective study of 82 cases

Introduction The birth anomaly of the coronary arteries is an infrequent cardiac malformation. Its incidence is 1% among congenital heart disease, it is largely underestimated because some forms are asymptomatic. The natural evolution of this pathology depends on the type of the CBA. Material and method Between 1998 and 2017, 82 cases of birth defects of the coronary arteries were identified in the department. Retrospectively analyzed were the presence or absence of congenital heart disease, clinical presentation with the circumstances of discovery, ECG, chest X-ray, TTE, and coronary angiography data. Results The average age was 44.16 years, there was male predominance (63.41%). Only 10 patients had underlying congenital heart disease. Among the patients, 68.29% had at least one cardiovascular risk factor. The circumstances in which coronary birth defects were discovered were: stable angina in 21.95% of cases, acute coronary syndrome without ST in 36.6%, acute coronary syndrome with ST in 12.9% of cases and heart failure in 13.41% of cases, syncope in 1.21%. In 8.43% of patients, the discovery was fortuitous. Chest x-ray was limited, showing cardiomegaly with no specificity in 31.7% of patients. The ETT performed in all patients showed an EF low in 36.58%. At the coronary angiography, 73 patients (89.02%) had aortic birth defects distributed as follows: 31.7% with multiple ostia, 28.04% had an abnormal birth of the right or left coronary of the opposite sinus, 11 patients or 13.41% had an abnormal birth of the RC or LC from the non-coronal posterior sinus, and finally 10 cases or 12.19% of cases had a birth variation compared to the adequate valsalva sinus. Three patients had an unclassified birth defect. Nine patients have a left coronary nascent pulmonary artery. Conclusion Coronary birth defects constitute a wide variety of abnormalities with very diverse clinical expressions. The birth of the left coronary from the pulmonary artery and the birth from the opposite sinus are the most productive of clinical manifestations.