ANOMALOUS LEFT CORONARY-ARTERY FROM THE PULMONARY-ARTERY - SIGNIFICANCE OF INTERCORONARY COLLATERALS

Seventeen patients with an anomalous left coronary artery from the pul monary trunk underwent surgical treatment and were evaluated, with a m ean follow-up of 9.5 years. Analysis has included clinical symptoms ca rdiac laboratory tests, angiographic grading of intercoronary collater als, echocardiographic and angiographic measurement of left ventricula r function, surgical methods, and the postoperative outcome. Ten patie nts (59%) survived, and there were seven early deaths. The only signif icant variable relating to survival was the extent of preoperative int ercoronary connections. In survivors, the postoperative left ventricul ar ejection fraction increased from 45% +/- 25% to 64% +/- 14% (p < 0. 01). Nine of ten survivors are free of symptoms and have normal left v entricular function. Nevertheless, half of all created anastomoses wer e occluded within 2 years of the operation. We speculate that even if temporarily constructed, a dual coronary supply allows for left ventri cular recovery and normalization of function.