Anomalous origin of the left main coronary artery: anatomical correction and concomitant LIMA-to-LAD grafting

A 55-year-old woman with angina pectoris and exertional dyspnea underwent s urgical correction of an anomalous left main coronary artery (LMCA) origina ting from the right sinus of Valsalva. During the operation, the roof of th e intramurally coursing LMCA was opened into the aortic lumen, and a neo-co ronary ostium was created by suturing the circumference of the LMCA intima to the aortic intima. In addition, a left internal mammary artery (LIMA) to left anterior descending (LAD) coronary artery anastomosis was performed. Postoperative coronary angiography demonstrated two independent, patent ori fices of both the LMCA and the right coronary artery. The technique present ed herein, of combined anatomical correction and LIMA-to-LAD grafting, is f easible and leads to distinct angiographic and clinical improvement. (C) 19 99 Published by Elsevier Science B.V. All rights reserved.