Anomalous left coronary artery originating from the pulmonary artery. Detailed follow-up report of successful ligation of the aberrant vessel in two infants.

Reestablishment of aortic flow to the coronary vasculature is the optimal treatment for anomalous origin of the left coronary artery originating from the pulmonary artery (ALCA). We performed intraoperative transesophageal echocardiography (TEE) in five patients (median age 10 months; range 1.5-36 months) who underwent revascularization of the left coronary artery without coronary mobilization by creation of an aortopulmonary window and intrapulmonary tunnel to the os of the anomalous vessel. Tunnel geometry as well as supravalvar pulmonary course were well imaged. Revascularized left coronary artery antegrade flow from the aorta was documented in all via color and pulse wave Doppler. A peribaffle leak (left-to-right shunt) was noted in 2 of the 5 patients, however its presence did not influence left coronary artery flow or clinical outcome. Intraoperative TEE is helpful in assessing adequacy of repair and documenting antegrade aortic flow in the left coronary artery after intrapulmonary tunnel repair for ALCA.