Chiariello L, Meyer J, Reul G J, Hallman G L, Cooley D A
Ann Thorac Surg. 1975 Apr;19(4):443-50. doi: 10.1016/s0003-4975(10)64046-5.
Anomalous origin of the left coronary artery from the pulmonary artery carries a poor prognosis; most patients die early in life from myocardial infarction and congestive heart failure. During a 12-year period at the Texas Heart Institute, 13 patients with this congenital malformation ranging in age from 1 to 24 years underwent operation. The anomalous coronary artery was sutured or ligated, or both, close to the pulmonary artery in 3 patients, 2 before 1965. Aortocoronary bypass was performed in the remaining 10 patients, using an autogenous saphenous vein graft in 9 and a Dacron tube in 1. More recently a distal end-to-side anastomosis has been employed and is not the preferred method. If necessary, a pump oxygenator may be used to complete the procedure. The only death was that of the first patient in the series who underwent ligation of the left coronary artery and mitral annuloplasty for severe mitral insufficiency; Of the 12 patients available for long-term follow-up study, all but 1 were asymptomatic. Follow-up angiographic studies showed the graft to be patent in 7 patients; the longest period of graft patency was 8 years. Definitive operative therapy is preferable to simple ligation because it eliminates the left-to-right shunt from the right coronary artery to the pulmonary artery and establishes a double coronary artery system.
左冠状动脉起源于肺动脉预后较差；大多数患者早年死于心肌梗死和充血性心力衰竭。在德克萨斯心脏研究所的12年期间，13例年龄在1至24岁之间患有这种先天性畸形的患者接受了手术。3例患者（2例在1965年之前）将异常冠状动脉在靠近肺动脉处进行了缝合或结扎，或两者都进行了。其余10例患者进行了主动脉冠状动脉搭桥术，9例使用自体大隐静脉移植，1例使用涤纶管。最近采用了远端端侧吻合术，但这不是首选方法。如有必要，可使用体外循环泵来完成手术。唯一的死亡病例是该系列中的首例患者，该患者因严重二尖瓣关闭不全接受了左冠状动脉结扎和二尖瓣环成形术；在12例可进行长期随访研究的患者中，除1例患者外均无症状。随访血管造影研究显示7例患者的移植血管通畅；移植血管通畅的最长时间为8年。明确的手术治疗优于单纯结扎，因为它消除了从右冠状动脉到肺动脉的左向右分流，并建立了双冠状动脉系统。
