Embryology of coronary arteries and anatomy/pathophysiology of coronary anomalies. A comprehensive update

• Published in: International journal of cardiology 2019-04, Vol.281, p.28-34
• Main Authors: Tomanek, Robert, Angelini, Paolo
• Format: Article
• Language: English
• Subjects: Animals; Coronary ostium; Coronary Vessel Anomalies - diagnostic imaging; Coronary Vessel Anomalies - physiopathology; Coronary Vessels - anatomy & histology; Coronary Vessels - diagnostic imaging; Coronary Vessels - physiopathology; Embryonic Development - physiology; Heart development; Humans; Neural crest cells; Notch signaling; Pathophysiology; Ultrasonography, Interventional - methods
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2018.11.135

This paper reviews new findings in both embryology of coronary arteries and in clinical observations of coronary artery anomalies. Our presentation emphasizes studies based on: 1) newer methods of coronary development in animals and humans, and 2) intravascular ultrasonography to interpret pathophysiology and guide treatment of coronary anomalies. New data reveal the roles of many cellular interactions and signaling pathways involved in the normal and abnormal formation of the coronary arterial system and the consequences of their defective formation. Pathogenetic developmental mechanisms include dysfunction of the Notch and Hypo signaling pathways, angiogenic and arteriogenic molecules, and neural crest cells. We addressed numerous clinically significant coronary anomalies and their prevalence in a general population (especially those characterized by an ectopic origin with aortic intramural course), and point out the critical relevance of understanding the variable mechanisms of coronary dysfunction, especially, fixed versus phasic stenoses or intermittent spasm, and individual severity of clinical presentations. •New insights into normal and abnormal coronary artery embryogenesis and their relevance to data from intravascular ultrasonography.•Many cellular and molecular interactions involved in coronary development and Possible anomalies that may result from dysfunctions in Notch and Hypo signaling pathways, angiogenic and arteriogenic molecules and neural crest cells.•Discussions underscore the critical relevance of various cellular and molecular mechanisms and their implications for coronary dysfunction.•Special consideration of fixed versus phasic stenosis or intermittent spasm, and “left ventricular non-compaction.”