Anomalous origin of left coronary artery from the pulmonary artery: Our 30 years of surgical experience and outcomes

Background: The aim of this study was to evaluate our 30 years of surgical experience and outcomes in management of anomalous origin of left coronary artery from the pulmonary artery with various age groups. Methods: Between March 1992 and August 2022, a total of 21 patients (10 males, 11 females; mean age: 16.3±15.9 years; range, 1 to 64 years) diagnosed with anomalous origin of left coronary artery from the pulmonary artery who underwent successful surgical repair were retrospectively analyzed. An initial diagnosis was made with two-dimensional echocardiography. Cardiac catheterization and angiography were performed in all our patients. Results: The median follow-up was five (range, 1 to 14) years. The mean left ventricular ejection fraction was 43.47±14.30% with associated moderate-to-severe mitral regurgitation in seven (33.33%) patients. Coronary button transfer was performed in 15 (71.42%) patients, Takeuchi repair in four (19.04%) patients, and ligation of anomalous left main coronary artery and ligation with great saphenous venous graft in one (4.76%) patient. There was no mortality. However, two (9.52%) patients had prolonged intensive care unit stay (>7 days). At the final follow-up, the mean left ventricular ejection fraction improved to 57.47±4.97%. Regression of moderate mitral regurgitation was observed in four (66.6%) patients. Conclusion: Preoperative left ventricular function is a major risk factor of perioperative mortality and morbidity. Mitral valve intervention is not warranted concomitantly in patients with moderate mitral regurgitation, if there are no structural lesions. Early diagnosis and meticulous surgical technique can yield excellent results and good long-term outcomes.