Hemodynamically significant anomalies of the coronary arteries. Surgical aspects.

In 78 (0.9%) of 8,283 patients without associated congenital heart disease studied by angiography, one or more major elements of the coronary arterial system originated in an ectopic manner. Symptoms attributable to the aberrant vessel more present in 20 of the 78 patients and in 15 patients these anomalies were treated surgically. The hemodynamically significant anomalies which lead to abnormalities of myocardial perfusion are of particular surgical importance. There are 4 major types: 1) aberrant origin of the left anterior descending branch from the pulmonary artery; 2) origin of the left coronary artery from the right aortic sinus; 3) origin of the left coronary artery from the pulmonary artery and 4) severe atherosclerotic occlusive disease in an aberrant vessel. The incidence, angiographic features and surgical aspects of these anomalies are discussed.