The midterm outcomes of coronary artery bypass grafting for adult anomalous origin of the left coronary artery from the pulmonary artery.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart disease. It presents as myocardial infarction in children; however, the presentation may vary between asymptomatic to progressive heart failure and also death. As a result, diagnosis in living adults is extremely rare. Different techniques have been mentioned for management of ALCAPA presenting in adults. In our retrospective case study, we present two adults, one male and one female, aged 33 and 49 years, respectively, who underwent transpulmonary direct closure of ALCAPA with left internal thoracic artery anastomosis to the left anterior descending artery and saphenous venous graft to obtuse marginal (OM) major, under standard cardiopulmonary bypass, thus forming a two-coronary system. On 5-year follow-up, both patients were doing well on echocardiography with good biventricular function, and follow-up computed tomography (CT) coronary angiography was carried out showing patent grafts. Therefore, establishment of a two-coronary system in adult ALCAPA can be considered as one of the gold standard treatments. In adult ALCAPA, coronary artery bypass grafting (CABG) is superior to other techniques in terms of alleviation of symptoms, survival, procedural ease, and improvement of left ventricular (LV) function.