Anomalous left coronary artery from the pulmonary artery. Significance of intercoronary collaterals

Seventeen patients with an anomalous left coronary artery from the pulmonary trunk underwent surgical treatment and were evaluated, with a mean follow-up of 9.5 years. Analysis has included clinical symptoms cardiac laboratory tests, angiographic grading of intercoronary collaterals, echocardiographic and angiographic measurement of left ventricular function, surgical methods, and the postoperative outcome. Ten patients (59%) survived, and there were seven early deaths. The only significant variable relating to survival was the extent of preoperative intercoronary connections. In survivors, the postoperative left ventricular ejection fraction increased from 45% +/- 25% to 64% +/- 14% (p < 0.01). Nine of ten survivors are free of symptoms and have normal left ventricular function. Nevertheless, half of all created anastomoses were occluded within 2 years of the operation. We speculate that even if temporarily constructed, a dual coronary supply allows for left ventricular recovery and normalization of function.