INDIVIDUAL ANATOMY DEMANDS VARIOUS TECHNIQUES IN CORRECTION OF AN ANOMALOUS ORIGIN OF THE LEFT CORONARY-ARTERY IN THE PULMONARY-ARTERY

Anomalous origin of the left coronary artery (ALCA) from the pulmonary artery is a rare cardiac anomaly. It can result in decreased myocardi al perfusion and impaired left-ventricular function, which can lead to congestive heart failure or even myocardial infarction. Reconstructiv e surgery of the left coronary artery is the desirable measure in the management of this anomaly. Since July 1992, five patients with ALCA f rom the pulmonary artery were treated surgically. Age at operation ran ged from 3 months to 11 years. Three patients had congestive heart fai lure and one was in cardiogenic shock. Operative techniques included ' 'tunnel type'' surgery in three cases and aortic reimplantation in two . Two operative variations per formed successfully in this series are described. There were no postoperative deaths. At the latest follow-up (mean 14 months), all anastomoses were patent and showed antegrade fl ow. For those patients with ALCA from the pulmonary artery, direct rei mplantation of the ALCA to the aorta is the most physiologically appro priate reconstructive solution, and offers good early and late results . Intrapulmonary tunnel from aortopulmonary window to coronary artery is recommended for children in whom aortic reimplantation is not anato mically feasible.