Anomalous origin of the left coronary artery: the effects of aortocoronary vein bypass on left ventricular function.

The diagnosis, angiographic evaluation and surgical treatment by aortocoronary vein bypass are described in a 3(1/2)-year-old girl with anomalous origin of the left coronary artery from the pulmonary artery. The anomaly had resulted in cardiac dilatation, diminished left ventricular contractility, an aneurysm of the left ventricular free wall and mitral regurgitation.At the postoperative cardiac catheterization the graft was demonstrated to be patent, but a significant proportion of the flow to the left coronary artery was derived from anastomotic connections with the right coronary artery. The most striking evidence of improvement was obtained from the left ventricular volume studies which showed that the end systoiic volume had decreased from 85 to 49 ml./m.(2) with an increase in ejection fraction from 0.39 to 0.62, suggesting enhanced left ventricular contractility after surgery.The patient continues to do well and is free from symptoms.