Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Successful Direct Reimplantation in a 50-year-old Man

Takemi Kawara, MD, Eiki Tayama, MD, Nobuhiko Hayashida, MD, Masaru Nishimi, MD, and Shigeaki Aoyagi, MD

Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital coronary artery anomaly that is often referred to as Bland White Garland syndrome. Most patients with this anomaly require surgical intervention early in life, and it is extremely rare that patients reach middle age without any symptoms. We present a 50-year-old man with this anomaly, who underwent direct reimplantation of the left main coronary trunk to the ascending aorta. His postoperative course was uneventful, and three and a half years after the operation, he is well and does not require medication. Several surgical procedures can be used to treat this anomaly, but we prefer to use direct reimplantation, whenever technically possible. To our knowledge, this patient is the oldest patient to have undergone a direct reimplantation without any angioplasty. (Ann Thorac Cardiovasc Surg 2003; 9: 197-201)

Key words: anomalous origin of the left coronary artery, Bland White Garland syndrome, coronary artery anomaly, direct reimplantation

From Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan

Received October 8, 2002; accepted for publication January 31, 2003
Address reprint requests to Takemi Kawara, MD: Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume-city, Fukuoka 830-0011, Japan.