[Anomalous origin of the left coronary artery from the pulmonary artery. Variability of clinical aspects, echocardiography and angiography findings].
OBJECTIVE
Analysis of symptoms, diagnostical difficulties and follow-up in infants and children with anomalous origin of the left coronary artery from the pulmonary artery.


METHODS
Retrospective study; 12 children between 3 weeks and 2 years old; time period: 1980-1991.


RESULTS
Three infants were detected on routine examination because of a new cardiac murmur, the others presented with signs of cardiac failure. Cross sectional echocardiography and color Doppler flow mapping allowed to verify the suspected diagnosis. However, in one infant a false-negative cross sectional echocardiographic result was obtained. In this case nuclear magnetic resonance imaging was able to delineate the exact anatomy. Mean preoperative left ventricular ejection fraction: 33 +/- 4%; percentage of infants below the age of 6 months: 92%; surgery related mortality: 66%; mean follow-up of the remaining 4 patients being in good clinical condition: 2.9 +/- 1 years.


CONCLUSIONS
1. An anomalous origin of the left coronary artery should be included into the differential diagnosis when a new cardiac murmur is detected. 2. Possibility of false-negative echocardiographic results is emphasized. 3. With early symptoms and highly reduced left ventricular function, the mortality is still high.
Breuer
J
J
Kinderklinik, Eberhard-Karls-Universität Tübingen.
Barth
H
H
Steil
E
E
Sieverding
L
L
Seboldt
H
H
Apitz
J
J
D000790:Angiocardiography; D003330:Coronary Vessel Anomalies / Q000175:diagnosis* / Q000601:surgery; D004200:Diseases in Twins; D004452:Echocardiography / Q000295:instrumentation*; D015150:Echocardiography, Doppler / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000295:instrumentation*; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000601:surgery
Fehlabgang der linken Koronararterie aus der Pulmonalarterie. Variabilität von Klinik, echokardiographischen und angiographischen Befunden.