Anomalous origin of left coronary artery. Evolution of surgical treatment.

Abstract

To evaluate contemporary surgical techniques in the correction of anomalous origin of the left coronary artery from the pulmonary artery. Eleven infants were operated upon during a ten year period by one surgeon. The anomalous coronary artery arose from the main pulmonary artery in ten and the right pulmonary artery in one patient. Direct reimplantation used in eight and the intra-pulmonary artery tunnel technique in three. Delayed sternal closure was used in the immediate post-operative period in five patients. There were no deaths within the 30 day post-operative period. At cardiac catheterisation and coronary angiography in seven patients, six showed normal left ventricular function and serial improvement of left ventricular shortening fractions. Pulmonary artery obstruction and aortopulmonary communications were observed in two patients in which the tunnel technique was used. One patient has required transplantation of the heart. Direct reimplantation is probably always possible and is the operation of choice. In the short and intermediate term there is improvement of left ventricular function in most patients.