Atypical Bland-White-Garland syndrome with stenosis of the origin of the left coronary artery: Catheter intervention after mammary artery bypass stenosis and residual fistula to the pulmonary trunk

A 16-year-old boy with anomalous origin of the left coronary artery from th e pulmonary artery, Bland-White-Garland syndrome, underwent a mammary arter y bypass grafting to the left coronary artery (LCA) together with closure o f the stenosed origin of the left coronary artery. A residual LCA to pulmon ary artery fistula and stenosis of the shunt at the implantation site devel oped that resulted in a dominant perfusion of the LCA from the right corona ry artery. Interventional catheterization was performed with stenting of th e LCA mammary artery anastomosis and subsequent coil occlusion of the resid ual fistula. After this intervention the LCA was exclusively perfused by th e mammarian bypass with no residual leak to the pulmonary artery.