Anomalous Left Coronary Artery from Pulmonary Artery

Abstract

Anomalous origin of the left coronary artery from the pulmonary artery has been noted in 11 patients at Children's Hospital of the District of Columbia from 1946 to 1969. Four of our cases plus 40 in the literature have been reported with complete catheterization data. These 44 infants and children can be divided into three groups (A, B, and C) according to the magnitude of the shunt at pulmonary artery level. The type of treatment in infants and children with anomalous left coronary artery and increased oxygen saturation in the pulmonary artery at the time of catheterization (group A) appears to be immaterial, as all have survived. Mortality rates in patients with left-to-right shunts not large enough to be detected by oxygen studies (group B) indicate no significant difference in those treated medically or surgically; hence, if possible, surgery should be delayed in this group until after 1 to 2 years of age when surgical mortality is negligible. In patients with filling of the left coronary artery from the pulmonary artery (group C), direct anastomosis of the anomalous left coronary artery to the aorta seems to be the only therapeutic recourse. To date, there are insufficient data to indicate the efficacy of direct anastomosis of the anomalous left coronary artery to the aorta in the sick infant.