European Journal of Cardio-Thoracic Surgery, Vol 10, 603-608, Copyright © 1996 by European Association for Cardio-thoracic Surgery
Anomalous origin of left coronary artery. Evolution of surgical treatment
F Moraes and C Lincoln
Department of Cardiac Surgery, Royal Brompton Hospital, London, UK.
OBJECTIVE: To evaluate contemporary surgical techniques in the correction
of anomalous origin of the left coronary artery from the pulmonary artery.
METHODS: Eleven infants were operated upon during a ten year period by one
surgeon. The anomalous coronary artery arose from the main pulmonary artery
in ten and the right pulmonary artery in one patient. Direct reimplantation
used in eight and the intra- pulmonary artery tunnel technique in three.
Delayed sternal closure was used in the immediate post-operative period in
five patients. RESULTS: There were no deaths within the 30 day
post-operative period. At cardiac catheterisation and coronary angiography
in seven patients, six showed normal left ventricular function and serial
improvement of left ventricular shortening fractions. Pulmonary artery
obstruction and aortopulmonary communications were observed in two patients
in which the tunnel technique was used. One patient has required
transplantation of the heart. CONCLUSION: Direct reimplantation is probably
always possible and is the operation of choice. In the short and
intermediate term there is improvement of left ventricular function in most
patients.
