Anomalous Origin of the Left Coronary Artery Arising from the Main Pulmonary Artery

Anomalous left coronary artery arising from the main pulmonary artery, although rare, should be differentiated from other diseases caus ing cardiomegaly or myocardial infarction in an acyanotic infant. A definitive diagnosis can be established by typical electrocardiographic, radioisotopic, and angiocardiographic findings. The clinical course is variable, depending on the age of onset and on the direction and magni tude of the blood flow through the anomalous vessel. Recent surgical advances offer new hopes for a better prognosis. Echocardiography and systolic time intervals are noninvasive means suitable for monitoring the myocardial functions periodically. The author suggests the use of nitro glycerin ointment as an important part of medical management, and the adoption of a modified surgical technique for coronary transferral in selected patients.