Five patients with anomalous connection of the left coronary artery to the pulmonary artery by an intramural route, whose ages ranged from 3 months to 11 months, were operated from 1987 to 1997. The diagnosis of the intramural aortic route was only made during the operation. In 4 patients a new technique was used. After establishment of the intramural aortic route, the pulmonary trunk was opened and the left coronary artery explored with a probe in order to identify its traject. Then, the aortic wall was opened and the intramural portion of the left coronary artery was opened longitudinally. The intima of the coronary artery was sutured to the intima and media layer of the aortic wall, creating an aortocoronary window. Finally, the origin of the left coronary was ligated. These 4 patients were followed-up from a period of 7 months to 10 years. They present clinical and echocardiographic improvement. All are in functional class I (NYHA), without medication. The only death occured 6 months after the operation. In this patient the intramural portion of the left coronary artery was divided from the aortic wall and the coronary artery reimplanted. There was several postoperative complications and the patient died suddenly 6 months after the operation. In this anomaly, the attempt to separate the left coronary artery from the aortic wall must be avoided. The described technique permits a safe and simple surgical correction of this rare anomaly, with good long-term results.
Pulmonary artery; Pulmonary artery; Coronary vessel anomalies; Cardiac surgical procedures; Cardiovascular surgical procedures; Aorta
