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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 1049-1057, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
CL Backer, MJ Stout, VR Zales, AJ Muster, TJ Weigel, FS Idriss and C Mavroudis
Children with anomalous origin of the left coronary artery from the
pulmonary artery are at risk for myocardial infarction and death. Surgical
management of this condition in children has evolved significantly during
the past 20 years. Between 1970 and 1990, a total of 20 of these patients
underwent surgical intervention at two institutions. Age at operation
ranged from 3 weeks to 11 years (mean, 26 months). Twelve patients had
congestive heart failure, three were in cardiogenic shock, and two had
cardiac murmurs. Operative techniques included ligation (n = 9), subclavian
artery anastomosis (n = 5), aortic implantation (n = 3), internal mammary
artery anastomosis (n = 1), intrapulmonary tunnel from aortopulmonary
window to coronary artery (n = 1), and cardiac transplantation (n = 1). The
three deaths in the series occurred at 3 weeks, at 2 months, and at 9 years
after ligation. There have been no deaths after establishment of a two
coronary artery system or after transplantation. Two of the five patients
who had subclavian artery anastomosis to the anomalous coronary artery have
severe anastomotic stenosis and collateralization. For patients with
anomalous origin of the left coronary artery from the pulmonary artery, we
recommend direct aortic implantation of the anomalous coronary artery at
the time of diagnosis. Intrapulmonary tunnel from aortopulmonary window to
coronary artery, or aorta-coronary bypass with internal mammary artery are
recommended for children in whom aortic implantation is not anatomically
feasible. Left coronary artery ligation is not indicated for these
patients; those who have survived ligation should be considered for
elective establishment of a two coronary artery system because of the risk
of late death.
ARTICLES
Anomalous origin of the left coronary artery. A twenty-year review of surgical management
Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Northwestern University Medical School, Chicago, IL 60614.
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