Anomalous origin of the left coronary artery: A twenty-year review of surgical management

C. L. Backer, M. J. Stout, V. R. Zales, A. J. Muster, T. J. Weigel, F. S. Idriss, C. Mavroudis

Research output: Contribution to journalArticle

Abstract

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 the late death.

Original languageEnglish (US)
Pages (from-to)1049-1058
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume103
Issue number6
StatePublished - Jan 1 1992
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Backer, C. L., Stout, M. J., Zales, V. R., Muster, A. J., Weigel, T. J., Idriss, F. S., & Mavroudis, C. (1992). Anomalous origin of the left coronary artery: A twenty-year review of surgical management. Journal of Thoracic and Cardiovascular Surgery, 103(6), 1049-1058.