The Journal of Thoracic and Cardiovascular Surgery, Vol 78, 12-20, Copyright © 1979 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Anomalous origin of left coronary artery from pulmonary artery in association with intracardiac lesions. Report of two cases
WD Wilcox, DJ Hagler, JT Lie, GK Danielson, HC Smith and RE Fulton
Two cases are presented to illustrate the diagnostic and therapeutic
dilemma when an anomalous origin of the left coronary artery from the
pulmonary artery occurs with a hemodynamically significant intracardiac
lesion. Hemodynamic alterations resulting from the associated intracardiac
lesion may obscure the clinical features of the coronary arterial
abnormality, and the appearance of normal coronary arterial distribution
with left ventricular or aortic root angiography may create a false
impression of a normal origin of the coronary arterial supply. A high index
of suspicion may be the only lead to the detection of an anomalous origin
of the left coronary artery from the pulmonary artery in association with
an intracardiac lesion. In addition to the intracardiac lesion known to be
associated with coronary arterial abnormalities, the question of anomalous
coronary supply should be raised by the finding of poor left ventricular
function or mitral insufficiency after operation (unexplainable by other
causes), by the development of poor myocardial function during cardiac
catheterization or anesthesia, or by the significant enlargement of a
coronary artery seen during left ventriculography or supravalvular
aortography.
