Nomenclatura

Congenital Heart Surgery Nomenclature and Database Project: Anomalies of the Coronary Arteries
Ali Dodge-Khatami, MD, Constantine Mavroudis, MD, and Carl L. Backer, MD
Division of Cardiovascular-Thoracic Surgery, Northwestern University School of Medicine, Department of Surgery, Children’s Memorial Hospital, Chicago, Illinois

The extant nomenclature for coronary artery anomalies is reviewedfor the purpose of establishing a unified reporting system. The subject was debated and reviewed by members of the STS-Congenital Heart Surgery Database Committee and representatives from the European Association for Cardiothoracic Surgery. All efforts were made to include all relevant nomenclature categories using synonyms where appropriate. The seven major categories of coronary arteryanomalies are: anomalous pulmonary artery origins of the coronaries, anomalous aortic origins of the coronaries, congenital atresia of the left main coronary artery, coronary artery fistulas, coronary

artery bridging, coronary aneurysms, and coronary stenosis. A comprehensive database set is presented which is based on a hierarchical scheme. Data are entered at various levels of complexity and detail,which can be determined by the clinician. These data can lay the foundation for comprehensive risk stratification analyses. A minimum database set is also presented, which will allow for data sharing and would lend itself to basic interpretation of trends. Outcome tables relating diagnoses, procedures, and various risk factors are presented. (Ann Thorac Surg 2000;69:S270 –97) © 2000 by The Societyof Thoracic Surgeons

I. Background

T

he incidence of coronary anomalies is 0.2% to 1.2% of the population. Various anomalies have been described since the 18th century, both clinically and on pathology studies, but the first landmark article, attempting a comprehensive classification, was by Ogden in 1969 [1], to which most authors refer, and from which the many modifications ofnomenclature derive. Congenital variations of the coronary artery (Ogden, 1969) include: Minor coronary variations High take-off Multiple ostia Anomalous circumflex artery origin Anomalous anterior descending artery origin Absent proximal ostium/single ostium in other aortic sinus Hypoplastic proximal coronary artery Congenital proximal coronary artery Congenital distal stenosis Coronary artery from theposterior aortic sinus Ventricular origin of an accessory coronary artery Major coronary anomalies Coronary “arteriovenous” fistula Anomalous origin from the pulmonary artery Left coronary artery
Presented at the International Nomenclature and Database Conferences for Pediatric Cardiac Surgery, 1998 –1999. Address reprint requests to Dr Mavroudis, Division of CardiovascularThoracic Surgery,Children’s Memorial Hospital, 2300 Children’s Plaza, m/c 22, Chicago, IL 60614; e-mail: c-mavroudis@nwu.edu.

Right coronary artery Both coronary arteries Secondary coronary anomalies Secondary coronary “arteriovenous” fistula Variations in transposition of the great vessels Variations in truncus arteriosus Variations in tetralogy of Fallot Ectasia of coronary arteries in supravalvular aortic stenosisMural coronary artery This classification includes major, minor, and secondary anomalies on the basis of anatomical but not clinical considerations (ie, minor, arising directly from the aorta and distal distribution normal; major, abnormal origin from the pulmonary artery (PA) or abnormal communications with intracardiac structures). It is debatable whether minor and major are appropriate terms giventhe potential clinical and/or surgical significance. The term anomalies of the coronary arteries will serve to define the first hierarchy level. The second hierarchy level is formed by the following diagnoses: (1) Anomalous pulmonary origins of the coronaries (APOC) (2) Anomalous aortic origins of the coronaries (AAOC) (3) Congenital atresia of the left main coronary artery (CALM) (4) Coronary...