S&cal Treatment of Anomalous ori& of the Left Coronary Arte Pulmonary Artery Associated wig Tetralogy of Fallot from the

An 8-year-old boy with anomalous origin of the left coronary artery from the pulmonary artery associated with tetralogy of Fallot, which was definitely diagnosed preoperatively, was operated on with success. Direct implantation of the left coro- nary artery into the aorta following division of the left coronary artery from the pulmonary artery and, concomitantly, total repair for tetralogy of Fallot using an external valved conduit were performed. Postoperative cineangiogram revealed a hemodyna- mically well-repaired intracardiac condition and anterograde filling of the left coronary artery, com- pared with retrograde left coronary flow from inter- coronary collateral vessels preoperatively. To the best of our knowledge, there is not a pre- viously published report of anomalous origin of the left coronary artery from the pulmonary artery asso- ciated with tetralogy of Fallot that was treated surgi- cally with success. Anomalous origin of the left coronary artery (LCA) from the pulmonary artery is relatively rare, and the reported incidence ranges from 0.24% (l) to 0.26 to 0.46% (2) among all con- genital heart diseases. This anomaly usually is seen as an isolated lesion, but sometimes is as- sociated with other cardiac disease, for exam- ple, ventricular septa1 defect (VSD) (3-51, patent ductus arteriosus (PDA) (6), truncus arteriosus (7), and, more rarely, tetralogy of Fallot (5,8,91. Because pulmonary blood flow is maintained through the LCA draining into the main pulmonary artery through intercoronary collat- eral vessels supplied from the right coronary