Origin of the left anterior descending coronary artery from the pulmonary artery. 3 year angiographic follow-up after saphenous vein bypass graft and proximal ligation.

A 55 year old woman had an extremely rare congenital anomaly of the coronary circulation in which the left anterior descending coronary artery arose from the pulmonary artery. Proximal ligation and saphenous vein grafting to the aberrant vessel were performed. Five month and 3 year angiographic follow-up studies demonstrated 1) a widely patent vein graft, 2) regression of large collateral vessels between the right coronary and circumflex arteries and the left anterior descending artery, and 3) marked attenuation of the distal right coronary and left circumflex arteries on the 3 year study. This report describes the clinical course of the oldest reported patient with this unique coronary artery anomaly and the only angiographic study of the effect of ligation and saphenous bypass grafting on its natural history.