Congenital atresia of the left coronary ostium: diagnosis and surgical treatment.

An 11-year-old girl with congenital atresia of the left coronary ostium underwent coronary artery bypass grafting using the internal mammary artery. Before surgery, the patient complained of syncope on exertion. Exercise electrocardiogram (ECG), two-dimensional echocardiogram, and 201Tl myocardial scintigram were useful in establishing the diagnosis. Selective coronary angiograms showed typical findings. Postoperative recovery was uneventful; exercise ECG and stress 201Tl myocardial scintigram demonstrated improvement. Internal mammary artery graft is probably better than a saphenous vein graft as a coronary artery bypass graft in childhood and adolescence because of the long-term patency of this type of graft.