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Circulation, Vol 51, 976-987, Copyright © 1975 by American Heart Association

ARTICLES

Anomalous left coronary artery originating from the pulmonary artery. Report on 15 cases

J Askenazi and AS Nadas

Fifteen infants and children with the diagnosis of anomalous left coronary artery from the pulmonary trunk have been encountered at the Children's Hospital Medical Center, Boston, Massachusetts from 1958 to 1973. After thorough clinical and laboratory evaluation, they have been treated by anticongestive measures. Nine patients have had ligation of the anomalous left coronary artery at its entrance into the pulmonary artery; one patient has undergone coronary bypass surgery. The lelctrocardiogram proved to be the most helpful diagnostic clinical laboratory test, Vectorcardiograms are valuable not only in diagnosis but also in the follow-up of the patients from the prognostic point of view. The most sensitive tool for the definitive diagnosis is an aortic rool angiogram; we have no false negatives or false positives with this method. The twelve patients with complete cardiac catheterization data could be divided into three groups, according to the pressure and magnitude of the left-to-right shunt at the pulmonary level. All patients with an appreciable le?T-TO-RIGHT SHUNT SURVIVED. Patients in whom no left-to-right shunt could be demonstrated by angiography died. Half of the patients with only small left-to-right shunt survived; The results of surgical and medical treatment, were identical within the three groups. Medical management in infancy, according to coronary care principles, with definitive surgical correction at a later age, is the preferred treatment. Ligation of the anomalous left coronary artery is recommended in severely symptomatic infants with documented left-to- right shunt at the pulmonary artery level, who do not respond to medical management.

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