E. Raanani et al., INDIVIDUAL ANATOMY DEMANDS VARIOUS TECHNIQUES IN CORRECTION OF AN ANOMALOUS ORIGIN OF THE LEFT CORONARY-ARTERY IN THE PULMONARY-ARTERY, The thoracic and cardiovascular surgeon, 43(2), 1995, pp. 99-103
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.