Anomalous origin of the left coronary artery from the pulmonary artery. Surgical treatment by ostial occlusion through pulmonary arteriotomy.

Two cases of anomalous origin of the left coronary artery from the pulmonary artery are reported in asymptomatic patients 15 and 27 years of age, bringing to 30 the total number of cases of this anomaly reported in the postinfantile age group. ECG exercise tests demonstrated marked ischemic changes in both patients, but angina or abnormal shortness of breath did not develop in either patient during or after exercise. The anomalous vessel was interrupted by closure of its ostium through a pulmonary arteriotomy during cardiopulmonary bypass, a procedure felt to offer a distinct technical advantage in the surgical treatment of this condition. Following ligation of the anomalous vessel, ECG exercise tests no longer showed definitive evidence of myocardial ischemia. This is interpreted as evidence that ligation should reduce the incidence of exercise-induced sudden deaths in this anomaly.