[The Bland-White-Garland syndrome: hemodynamics, clinical picture, therapy]

Two patients with anomalous origin of the left coronary artery from the pulmonary artery are presented. Anatomy, embryology, the problem of the direction of blood flow in the anomalous vessel, and the clinical symptoms of this syndrome are discussed. In spite of large fibrotic areas in the myocardium, the ECG-changes were minimal. Therefore, a nearly normal ECG does not exclude this anomaly. In patients with sudden, unexpected death one should suspect an anomalous origin of a coronary artery. The classification in an "infantile" and "adult" type reflects the extent to which collateral vessels have developed. Ligation of the anomalous coronary artery at the side of its origin with concomitant aorto-coronary bypass appears to be a rational and the only effective way of therapy.