Abstract
The purpose of this study was to evaluate 3 patients 8-9 years after the ligation of an ALC at its insertion into the main pulmonary artery during the first year of life. The patients at 2, 4 and 8 months of age were in growth failure and profound congestive heart failure. Chest x-ray showed marked cardiomegaly and electrocardiogram (ECG) showed left ventricular enlargement (LVE) and deep Q waves in leads L1, AVL and V6 with flat to inverted T waves in the V leads. Cardiac catheterization (CC) and angiocardiography (A) showed the ALC (2, L-R; 1, bidirectional shunt), a dilated poorly contracting left ventricle (LV) in 3, and mitral insufficiency (MI) in 2 patients. All 3 patients had the ALC ligated and were asymptomatic and showed normal growth and development 8-9 years after operation. Two patients had normal heart size by x-ray and 1 showed only slight LVE. The ECG was normal in 1 and showed slight LVE by voltage in 2. Bicycle exercise stress test was normal in all 3, as was a Thallium 201 myocardial imaging scan. CC and A showed normal intercardiac pressures, slight dysfunction of the posterior wall of the LV in 2, slight MI in 2 and well developed collateral vessels from the right to the left coronary artery in 3. Although the present day popular treatment is to implant the ALC into the aorta either directly or with a graft, ligation may also give excellent results and preserve the developed collateral circulation.
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Hartmann, A., Martin, T., Bielio, D. et al. 149 LIGATION OF ANOMALOUS LEFT CORONARY (ALC). Pediatr Res 15 (Suppl 4), 464 (1981). https://doi.org/10.1203/00006450-198104001-00158
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DOI: https://doi.org/10.1203/00006450-198104001-00158
