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(Circulation. 1966;33:I-52.)
© 1966 American Heart Association, Inc.

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Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

Certain Therapeutic Considerations

ALDO R. CASTAÑEDA M.D., PH.D.¹; ROBERT A. INDEGLIA M.D.¹; RICHARD L. VARCO M.D., PH.D.¹

¹ From the Department of Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota.

Nine cases of anomalous origin of the left coronary artery from the pulmonary artery, the patients ranging in age from two months to seven years, have been reviewed. Six of these patients have had mitral insufficiency as well.

Of these nine patients, four have undergone operation and all have survived. There have been no postoperative complications. A fifth patient was taken to the operating room, but developed ventricular fibrillation during induction and could not be resuscitated. The remaining patients were not operated upon, and all have died.

In a typical case, nonspecific respiratory complaints were present. In addition, some patients experienced episodes of pallor, dyspnea, and excessive perspiration. The electrocardiogram and vectorcardiogram proved helpful in the diagnosis of this anomaly, although selective right coronary arteriography was most effective in establishing the diagnosis.

The surgical treatment in all four patients consisted of transection and ligation of the anomalous coronary artery at its origin from the pulmonary artery. The technique is simple and has been described. Of the four surgically treated patients, three have so far remained asymptomatic. One patient continues postoperatively to suffer from angina-like symptoms. The electrocardiogram, vectorcardiogram, and chest X-rays do not show any marked change from preoperative observations in three patients; however, the youngest child operated upon (aged three months) reveals changes consistent with improvement in the electrocardiographic pattern.

Early recognition and treatment of this lesion are advocated if preventable deaths from irreversible myocardial damage are to be avoided.