Congenital coronary artery anomalies angiographic classification revisited Rigatelli Gianluca 1 , Docali Giorgio 2 , Rossi Paolo 2 , Bovolon Daniela 2 , Rossi Daniele 2 , Bandello Attilio 2 , Lonardi Gabriele 2 & Rigatelli Giorgio 2 1 EndoCardioVascular Therapy Research; 2 Catheterization Lab, Department of Specialistic Medicine, ‘Mater Salutis’ Legnago General Hospital, Legnago, Verona, Italy Received 4 March 2003; accepted in revised form 21 March 2003 Key words: congenital heart disease, coronary artery angiography, coronary artery anomaly Abstract Many fragmental classification of coronary artery anomalies (CAAs) exist, but a simple practical angio- graphic classification for angiographers has been never proposed. This study is aimed to suggest a simplified angiographic classification of congenital CAAs based on just a few univocal common angiographic pat- terns. The authors reviewed 5100 coronary angiographies in order to select CAAs patients and identify simple common angiographic features. Sixty-two patients (1.21%, female/male 20/42, mean age 65.3 ± 10.6 years) had CAA on coronary angiography. The authors identified seven classes for seven angiographic patterns: I – hypoplasia/atresia, II – hyperdominance, III – fistula, IV – originating from wrong sinus, V – originating from other arteries, VI – splitting, and VII – tunnelling. A, P, B, R, L, PA, AO refer to anterior, posterior or passage between the aorta and pulmonary artery and to right, left, pulmonary artery and aorta. Three blind observers were be able to categorize all the CAAs according to this classi- fication with no inter-observer differences: 3.2% were classified as class I, 8.1% as class II, 3.2% as class III, 24.2% as class IV, 22.5% as class V, 29% as class VI, and finally 9.7% as class VII. Eleven patients (17.7%) had ‘A’ passage, 10 (16.1%) ‘P’ passage and 9 (14.5%) ‘B’ passage. Twelve patients (19.5%) had anomalous origin from the right sinus of Valsalva, 2 (3.2%) from the left. This simplified classification was applicable to all most significant CAAs and in the authors’ view it may make for a more rapid and univocal CAA angiographic description. Introduction Coronary artery anomalies (CCAs) occur in 0.64–5.6% of patients undergoing coronary angio- graphy [1–9]: their anatomic details and physio- pathological patterns are well known in most cases nowadays. On the contrary, a certain confusion exists as to their global angiographic classification, since classifications of CAAs are often fragmental and difficult to remember because they combine together anatomical, angiographic and clinical el- ements. This retrospective study aims to describe angiographic features which are common to all CAAs and to suggest a simple global practical angiographic classification. Methods and materials In a single-center retrospective study at a public hospital, a review of the last 5100 coronary angio- graphies was performed in order to select CAA patients and to identify common angiographic patterns A global angiographic classification of the CAAs in our series based on these patterns was attempted. The International Journal of Cardiovascular Imaging 19: 361–366, 2003. Ó 2003 Kluwer Academic Publishers. Printed in the Netherlands. 361