Anomalous origin of the left coronary artery (LCA) from pulmonary trunk (Bland-White-Garland syndrome) with systemic collateral supply to LCA.

We present the case of 15-year-old asymptomatic girl referred to our institution with the diagnosis of mitral valve prolapse and a suspicion of coronary artery fistula. Detailed diagnostics revealed Bland-White-Garland syndrome (B-W-G) with tortuous aneurysmatic right coronary artery (9 mm in diameter). In addition, on surgery, multiple collateral vessels between the right and left coronary arteries were found crossing over the pulmonary trunk and right ventricle. Because of fragile and calcified anterior walls of the main pulmonary artery we had to elect Hamilton rather than Takeuchi technique. The procedure was aggravated by continuous blood outflow from enlarged LCA ostium suggesting systemic collateral supply. Weaning from cardiopulmonary bypass and postoperative period was uneventful. There are only two published reports on systemic collateral supply to LCA in patients with BWG.