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Circulation, Vol 90, 2379-2384, Copyright © 1994 by American Heart Association

ARTICLES

Origin of both coronary arteries from the pulmonary artery

GE Urcelay, MD Iannettoni, A Ludomirsky, RS Mosca, JP Cheatham, DA Danford and EL Bove
Department of Pediatrics, University of Michigan, School of Medicine, Ann Arbor.

Origin of both coronary arteries from the pulmonary artery is generally a lethal condition from progressive ventricular failure. We report the clinical and surgical course of two infants, ages 3 and 6 months, with this anomaly. One patient had normal intracardiac anatomy with low pulmonary artery pressures (30/12 mm Hg). The second patient had a restrictive subpulmonic ventricular septal defect with a moderately elevated pulmonary artery pressure (50/13 mm Hg). Left ventricular ejection and shortening fractions were profoundly depressed in both patients. The common coronary trunk arose from the right anterior facing sinus in one patient and from the left posterior facing sinus in the other. Both patients underwent repair by direct coronary implantation to the aorta. Left ventricular function improved with shortening fractions near normal at a follow-up of 6 months for one patient and 1 year for the other. Early diagnosis and prompt repair is compatible with survival and return of normal shortening fraction.

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