Anomalous Origin of Left Coronary Artery from Pulmonary Artery. Evolution of Right and Left Coronary Circulation after Surgical Correction in Four Cases with Delayed Control

Summary

In 4 young girls (from 2 to 15 years) the diagnosis of abnormal origin of left coronary artery was made after left heart catheterization and angiography. In 3 cases a previous error of diagnosis was reversed.

In all 4 cases the main circulatory trouble was well illustrated with a large single right coronary artery arising from the aorta and secondary retrograde filling of the left coronary with left-to-right shunt.

The 3 first cases were treated by reimplantation of the left main truncus in the aorta using saphenous graft. The fourth, a 2-year-old child with mitral insufficiency, was treated by direct reimplantation of the left coronary ostium in the aorta associated with mitral annuloplasty.

The 4 girls are doing well with a follow-up range of 1 1/2 years to 4 years. Angiographic control was performed 7 to 14 months following surgery.

The 3 saphenous grafts are patent. The right coronary decreased to normal size, the collateral circulation disappeared and the left coronary perfusion is normal. Only the ECG is unchanged.

In the case with direct reimplantation closure of the implanted coronary ostium occurred but the result on cardiac ischemia and left ventricular enlargement is good with no mitral insufficiency revealed on echo and ventriculography.

In accord with Cooley and many other surgeons the authors think that the best treatment of such an anomaly is surgical creation of a double coronary circuit. In case of failure this is the equivalent of a simple ligature. Despite the failure of direct reimplantation this technique will be used in future cases involving young children to avoid the hazards of saphenous grafts.

Key words

Anomalous left coronary artery origin - Surgical correction - Saphenous vein graft interposition