ATRESIA OR CONGENITAL STENOSIS OF THE LEF T CORONARY OSTIUM MYOCARDIAL REVASCULARIZATION IN 5 YOUNG-PATIENTS

Five patients, 3 months to 13 year old with atresia (4) or stenosis (1 ) of the left coronary artery underwent myocardial revascularisation a t Marie Lannelongue Hospital. The preoperative symptoms were dominated in one case by cardiac failure due to myocardial infarction and in th e other cases by effort angina with syncope. The operative technique o f revascularisation in one case was angioplasty with enlargement of th e left main coronary artery with a patch and, in the others, bypass gr aft of the left coronary artery with the left internal mammary artey. All 5 patients survived surgery and are asymptomatic with a follow-up of 6 months to 7 years. Control coronary angiography confirmed the pat ency of the different procedures of myocardial revascularisation. In 3 children, exercise electrocardiography was normal. Myocardial revascu larisation of a child with a congenital stenotic abnormality of the le ft coronary network is possible, the technique of which depends on the diameter of the left main stenosis when the vessel is absent or atres ic, left internal mammary artery bypass graft is the only solution. Wh en the left main coronary is stenosed but patent, direct reconstructiv e surgery is an interesting alternative.