Towards an anatomically correct repair for anomalous left coronary artery arising from the pulmonary trunk.
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.
Muneer Amanullah
M
M
Division of Congenital Cardiac Surgery and Congenital Cardiology, The Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Rostron
Anthony J
AJ
Leslie Hamilton
J R
JR
Chaudhari
Milind P
MP
Hasan
Asif
A
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