Anomalous left coronary artery from the pulmonary artery: effect of coronary anatomy on clinical course.

Nine children and 1 adolescent with anomalous left coronary artery from the pulmonary trunk (ALCA) were studied between 1970 and 1982. Serial angiographic and hemodynamic data are compared with the clinical course. Four patients had separate conus coronary arteries with a major contribution to collateral flow. Eight patients survived various surgical procedures with 1 late death, 1 awaits operation, and 1 died in infancy. The authors' data show a significant potential for improvement in left ventricular function as shown by an increase in LV ejection fraction on medical therapy alone (5/6 patients), including all 4 with separate conus coronary arteries. The authors conclude that medical treatment alone may be indicated for a time in selected patients with ALCA, and a subgroup with a separate conus coronary artery may have a more favorable natural history.