Table 2.

Angelini classification of coronary artery anomalies (Continued on next page)

Anomalies of origination and course Absent left main trunk (split origination of LCA) Anomalous location of coronary ostium within aortic root or near proper aortic sinus of Valsalva (for each artery): High Low Commissural Anomalous location of coronary ostium outside normal “coronary” aortic sinuses Right posterior aortic sinus Ascending aorta Left ventricle Right ventricle Pulmonary artery Variants: LCA arising from posterior facing sinus LCX arising from posterior facing sinus LAD arising from posterior facing sinus RCA arising from anterior right facing sinus Ectopic location (outside facing sinuses) of any coronary artery from pulmonary artery From anterior left sinus From pulmonary trunk From pulmonary branch Aortic arch Innominate artery Right carotid artery Internal mammary artery Bronchial artery Subclavian artery Descending thoracic aorta Anomalous origination of the coronary ostium from opposite, facing “coronary” sinus (which may involve joint origination or adjacent double ostia). Variants: RCA arising from left anterior sinus, with anomalous course: Posterior atrioventricular groove* or retrocardiac Retroaortic† Between aorta and pulmonary artery† Intraseptal† Anterior to pulmonary outflow† or precardiac Posteroanterior interventricular groove† LAD arising from right anterior sinus, with anomalous course: Between aorta and pulmonary artery Intraseptal Anterior to pulmonary outflow or precardiac Posteroanterior interventricular groove LCX arising from right anterior sinus, with anomalous course: Posterior atrioventricular groove Retroaortic LCA arising from right anterior sinus, with anomalous course: Posterior atrioventricular groove† or retrocardiac Retroaortic† Between aorta and pulmonary artery† Intraseptal† Anterior to pulmonary outflow† or precardiac Posteroanterior interventricular groove† Single coronary artery Anomalies of intrinsic coronary arterial anatomy 6. Congenital ostial stenosis or atresia (LCA, LAD, RCA, LCX) Coronary ostial dimple Coronary ectasia or aneurysm 7. Absent coronary artery 8. Coronary hypoplasia 9. Intramural coronary artery (muscular bridge) 10. Subendocardial coronary course 11. Coronary crossing 12. Anomalous origination of posterior descending artery from anterior descending branch or septal penetrating branch 13. Absent PDA (split RCA) 14. Variants: (Proximal + distal) PDAs, both arising from RCA 15. Absent LAD (split LAD). Variants: LAD + first large septal branch LAD, double 16. Ectopic origination of first septal branch Anomalies of coronary termination 17. Inadequate arteriolar/capillary ramifications 18. Fistulas from RCA, LCA, or infundibular artery to: Right ventricle Right atrium Coronary sinus Superior vena cava Pulmonary artery Pulmonary vein Left atrium Left ventricle Multiple, right + left ventricles

^†If a single, common ostium is present, the pattern is considered to represent “single” coronary artery.