Congenital coronary artery anomalies. Experience at Stanford University Hospital (1963-1971).

Two cases are reported that illustrate the classic features of coronary artery anomalies. The Stanford experience during 1963 to 1971 is reviewed in detail, emphasizing diagnosis and management. Coronary arteriovenous fistulas are usually easily recognized by auscultation and are confirmed by aortography; surgical interruption is generally advised on a prophylactic basis. Clinically, anomalous origin of the left coronary artery from the pulmonary artery occurs in children in one of three ways: (1) an infantile type with symptoms of cardiorespiratory distress and often early death; (2) an intermediate type occurs with mild symptoms, growth retardation, and with electrocardiographic and x-ray film findings of myocardial ischemia; (3) an adult type in which patients become symptomatic late or never, but have electrocardiographic evidence of myocardial infarction. Surgical treatment is beneficial in selected cases.