Abstract
Both anomalous origin of the left main coronary artery from the pulmonary trunk and atherosclerotic coronary artery disease are conditions associated with myocardial ischemia. In contrast to atherosclerotic coronary artery disease, ischemia in the anomalous origin of the left main coronary artery from the pulmonary trunk is gradual in onset owing to the high pulmonary artery pressure that limits blood flow through the anomalous left coronary artery in the postnatal period. Survival to adulthood depends on the development of collateral circulation from the right coronary or may eventually be related to a marked right coronary artery dominance. 1 In contrast to atherosclerotic coronary artery disease, left ventricular ejection fraction is only moderately depressed or normal in most patients with anomalous origin of the left main coronary artery from the pulmonary trunk. 2 The energy required to build up myocardial highenergy phosphates is mainly generated by the mitochondrial respiratory chain. The present study suggests that different respiratory chain capacities in the myocardium of patients with these 2 forms of ischemic heart disease may account for the differences in left ventricular performance.
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