Name the origin and course of each coronary artery — the malignant course between the aorta and pulmonary artery (interarterial) with an intramural segment and slit-like ostium is the one linked to sudden death in young athletes.
Orient first
- Courses: interarterial, subpulmonic (septal), retroaortic, prepulmonic, retrocardiac.
- High-risk features: interarterial course, intramural segment, slit-like ostium, acute take-off angle.
- ALCAPA (left coronary from the pulmonary artery) presents in infancy or with collateral-dependent adults.
Acquire the study
- ECG-gated coronary CT angiography with MIP, curved and 3D reconstructions.
The manoeuvre
- Origin of each coronary artery from its sinus on axial slices.
- Course relative to the aorta and pulmonary artery on 3D and MIP.
- Intramural segment length in mm; ostial shape (slit-like) and take-off angle in degrees.
- Luminal narrowing of the proximal segment in %.
What confirms it
- An anomalous origin with a named course on gated angiography.
What licenses you to exclude it
- Normal origins and courses exclude a coronary anomaly.
The classic misread
- Calling a septal (subpulmonic) course malignant — it is usually benign.