Anomalous left coronary artery from the pulmonary artery - a therapeutic dilemma

An anomalous left coronary artery from the pulmonary artery was diagnosed clinically in 12 patients (and confirmed angiographically in 11 and at autopsy in 1). A classic history of 'infantile angina' was obtained in only 1 patient, while the typical electrocardiographic findings Of anterolateral ischaemia or infarction were present in 11 patients (92%). The majority had evidence of left ventricular dysfunction _and mitral regurgitation. Three patients underwent surgical reimplantation of the anomalous left coronary artery' into the ascending aorta. Two survive, but with persistent electrocardiographic changes and cardiomegaly. Nine patients, of whom 4 survive, were managed medically. Five of the 6 deaths occurred within 1 month of diagnosis. A conservative approach to surgical intervention is recommended, as surgery is unlikely to alter the ultimate prognosis