title: Towards an anatomically correct repair for anomalous left coronary artery arising from the pulmonary trunk.
abstract: BACKGROUND
  Anomalous origin of the left coronary artery from the pulmonary trunk is rare, occurring at an incidence of 1 in 300,000. If not diagnosed and treated early, it is life-threatening. Children with the anomaly usually present in infancy with congestive cardiac failure, and are occasionally referred for cardiac transplant. We investigated the medium term outcome for patients following creation of a two-coronary arterial circulation.
  
  
  METHODS
  Between 1992 and 2007, we diagnosed 15 patients seen at our Institution as having anomalous origin of the left coronary artery from the pulmonary trunk. Over a period of 13 years, aortic reimplantation was undertaken in 12 of these patients, who form the studied cohort.
  
  
  RESULTS
  Direct reimplantation was performed in 5 patients. In 3 cases, a tension-free anastomosis was created using a caudally based flap. In another 3 cases, an extended flap was used, while a patch arterioplasty was fashioned in the final patient. There were no deaths. Left ventricular function recovered in all but one of the patients, and all patients had a reduction in the degree of mitral regurgitation.
  
  
  CONCLUSIONS
  Among the variety of surgical techniques, transfer of the anomalous left coronary artery to the aorta is the ideal method for long-term patency and adequate blood supply. This can be achieved by creating flaps based on the walls of the pulmonary trunk and aorta, producing a dual coronary arterial supply with no mortality and low morbidity.
authors.affiliation: Division of Congenital Cardiac Surgery and Congenital Cardiology, The Freeman Hospital, Newcastle upon Tyne, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Muneer Amanullah
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Rostron
authors.forename: J R
authors.initials: JR
authors.lastname: Leslie Hamilton
authors.forename: Milind P
authors.initials: MP
authors.lastname: Chaudhari
authors.forename: Asif
authors.initials: A
authors.lastname: Hasan
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D001011:Aorta / Q000601:surgery; D002675:Child, Preschool; D015331:Cohort Studies; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography