LONG-TERM FOLLOW-UP AFTER 2 CORONARY REPAIR OF ANOMALOUS LEFT CORONARY-ARTERY FROM THE PULMONARY-ARTERY

A retrospective analysis of ten patients with anomalous left coronary artery arising from the pulmonary artery operated between 1979 and 199 0 was undertaken. All presented with evidence of left ventricular dysf unction and ''ischemic'' mitral regurgitation. Surgical repair consist ed of an aortopulmonary tunnel (Takeuchi) procedure in eight and direc t left coronary artery reimplantation in two. Two patients required po stoperative support with a left ventricular assist device. There were no operative or late deaths (CL 0% to 17%) for a follow-up of over 670 patient months. All patients are in New York Heart Association Class I or II, though two patients are still receiving anticongestive medica tions. One patient has required further surgery for pulmonary artery s tenosis, and another has had a mitral valve replacement because of sev ere mitral regurgitation. One additional patient has moderate-to-sever e residual mitral regurgitation and two have a trivial left coronary t o main pulmonary artery fistula. All have a patent, nonstenotic left c oronary artery and much improved left ventricular function and perfusi on as assessed by echocardiography, thallium scan, gated blood pool sc an, and angiography. There have been no documented arrhythmias, clinic ally or on Holter monitoring. The ECGs have shown resolution or improv ement of the initial changes of ischemia/infarction in all patients. C hest X-rays have shown normalization of cardiothoracic ratio in eight of ten patients. Excellent early and late results can be achieved foll owing timely surgical repair. Marked improvement in left ventricular f unction has been observed in patients with poor preoperative left vent ricular function, even in the presence of extensive ischemia/infarctio n.