Anomalous Left Coronary Artery Originating from the Pulmonary Artery

RECENT reports have indicated that anomalous coronary arteries originating from the pulmonary artery may act as a channel for left-to-right shunt.1-4 Thus a large portion of the coronary blood flow may bypass the coronary capillary bed, pass through arterial anastomoses, and enter directly into the pulmonary artery by retrograde flow through the anomalous coronary with resultant myocardial ischemia. In infants suspected of having this anomaly, early death has been ascribed to this mechanism. This has resulted in a strong plea for early ligation of the aberrant coronary artery in an attempt to redistribute the coronary flow throughout the entire capillary bed.' The observation of successful ligation of the aberrant vessel in one case, with prolonged postoperative follow-up, and of sudden death after the same procedure in another, has led to a revised evaluation of this problem and has prompted this report.