Anomalous origin of left coronary artery. Evolution of surgical treatment

Abstract

OBJECTIVE: To evaluate contemporary surgical techniques in thecorrection of anomalous origin of the left coronary artery from thepulmonary artery. METHODS: Eleven infants were operated upon during a tenyear period by one surgeon. The anomalous coronary artery arose from themain pulmonary artery in ten and the right pulmonary artery in one patient.Direct reimplantation used in eight and the intra- pulmonary artery tunneltechnique in three. Delayed sternal closure was used in the immediatepost-operative period in five patients. RESULTS: There were no deathswithin the 30 day post-operative period. At cardiac catheterisation andcoronary angiography in seven patients, six showed normal left ventricularfunction and serial improvement of left ventricular shortening fractions.Pulmonary artery obstruction and aortopulmonary communications wereobserved in two patients in which the tunnel technique was used. Onepatient has required transplantation of the heart. CONCLUSION: Directreimplantation is probably always possible and is the operation of choice.In the short and intermediate term there is improvement of left ventricularfunction in most patients.