الفهرس 
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Abstract
Coronary artery anomalies (CAAs) are a diverse group of congenital disorders whose manifestations and pathophysiological mechanisms are highly variable. The subject of CAAs is undergoing profound evolutionary changes related to the definition, morphogenesis, clinical presentation, diagnostic workup, prognosis, and treatment of these anomalies. To understand the clinical impact of CAAs, the fundamental challenge is the firm establishment, for a particular type of CAA, of a mechanism capable of interference with the coronary artery’s function, which is to provide adequate blood flow to the dependent myocardium. The coronary arteries are the only branches of the ascending aorta, and they supply blood to all structures within the pericardial cavity. Usually, the 2 coronary artery ostia are located in the center of the left and right (anterior) sinuses of the aortic valve. The posterior sinus of the aortic valve contains no coronary ostium and is often designated as the noncoronary sinus. Abnormalities of the origin of coronary arteries with subsequent normal epicardial course relate to the anomalous location of one or both coronary ostia. These include the origin of LM, LAD, LCx, or RCA from the pulmonary trunk. In addition, coronary arteries may originate directly from the left or right ventricles; the bronchial, internal mammary, subclavian, right carotid, or innominate arteries; the aortic arch; or the descending thoracic aorta. High takeoff of the left or right coronary ostia, defined as the location of the ostium of the left or right coronary artery more than 1 cm above the sinotubular junction, has been described.Congenital coronary artery abnormalities are rare, isolated anomalies that are important to recognize in childhood. Usually, isolated coronary anomalies are asymptomatic; however, certain forms are associated with myocardial ischemia, congestive heart failure, and sudden cardiac death in infants and children. Recognition of signs and symptoms that may indicate a congenital coronary artery anomaly should lead to additional testing, especially thorough evaluation of coronary artery anatomy using two-dimensional and color Doppler echocardiography. Coronary artery anomalies are some of the most confusing, neglected topics in cardiology. Although the medical community and general public are increasingly aware that coronary anomalies can be fatal (typically in young, previously “healthy” athletes), the reasons for the sudden fatal event and the frequency with which it occurs are generally unclear. To promote a less casual approach to this subject, we review some basic, substantive, and methodological questions about coronary anomalies.