Coronary artery anomalies

The most frequent coronary artery anomaly is Bland-White-Garland syndrome, in which the left coronary artery originates from the main trunk of the pulmonary artery. The clinical symptoms are characterised by ischaemia in the region supplied by the left coronary artery. Depending on the development of collaterals from the right to the left coronary artery, severe infarction may occur even in early infancy or exercise-induced ischaemia may occur only later in life.

Measures that create a physiological two-coronary artery system are preferred today. Direct reimplantation of the left coronary artery into the aorta is currently the method of choice. If this procedure is technically impossible, possible alternatives include end-to-end anastomosis of the left coronary artery to the left subclavian artery (Schmitz et al. 1997), ligature of the left coronary artery in conjunction with an aortocoronary bypass or creation of an aortopulmonary window and construction of an intrapulmonary tunnel.