Subclavian--left coronary artery anastomosis (Meyer operation) for anomalous origin of the left coronary artery from the pulmonary artery.

Six patients, ages 2--76 months, had subclavian--coronary artery anastomosis (the Meyer operation) through a left thoracotomy without cardiopulmonary bypass for anomalous origin of the left coronary artery. Five of the six had congestive heart failure and ischemic abnormalities on the ECG. All six had cardiomegaly by chest x-ray. Preoperative left ventricular rejection reactions averaged 0.46 +/- 0.171. In three patients in whom peak systolic pressure was measured in the left coronary artery at operation, pressure increased by a mean of 26 mm Hg when the anastomosis was unclamped. One patient died. Five patients are alive 8--92 months postoperatively and four of the five anastomoses were patent at postoperative cardiac catheterization. Postoperative ECGs were normal or showed reduced T-wave abnormalities in all patients, and heart size by chest x-ray has decreased or is normal. Postoperative ejection fractions increased by a mean of 0.12 in four of the five patients (p = 0.01). On patient had a normal ejection fraction preoperatively and it remained unchanged postoperatively. No patient receives cardiac medications or is symptomatic at late follow-up. The Meyer operation can be performed at an early age, establishes a two-coronary-artery system, has growth potential, requires one vascular anastomosis, and in this series, resulted in reversal of left ventricular ischemic changes and improvement in left ventricular contractility.