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The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 25-29, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
KA Kesler, DG Pennington, S Nouri, E Boegner, KR Kanter, L Harvey, SC Chen, S Juriedini, I Balfour and VL Willman
From 1972 to 1987, seven patients, from two to 28 months of age, underwent
left subclavian artery-left coronary artery anastomosis for anomalous
origin of the left coronary artery from the pulmonary trunk. All of these
infants, median age 4 months, had severe congestive heart failure caused by
anterolateral myocardial infarctions. There were two hospital deaths (29%
mortality rate) with no late deaths after an average 10-year follow-up. All
survivors have good exercise tolerance New York Heart Association class I),
reduction in heart size, and significant improvement or normalization of
ventricular function by echocardiography. Patency of the subclavian-left
coronary artery anastomosis has been documented in two of four patients who
have undergone catheterization. In contrast to other revascularizing
procedures for treatment of an anomalous origin of the left coronary
artery, anastomosis of the left subclavian to the left coronary artery may
be performed without cardiopulmonary bypass or aortic occlusion. Moreover,
this procedure appears to have an acceptable mortality rate with excellent
long-term functional results in critically ill infants.
ARTICLES
Left subclavian-left coronary artery anastomosis for anomalous origin of the left coronary artery. Long-term follow-up
Department of Surgery, St. Louis University School of Medicine, MO 63104.
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