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(Chest. 1994;106:1920-1922.)
© 1994 American College of Chest Physicians

Delayed Presentation of Anomalous Circumflex Coronary Artery Arising From Pulmonary Artery Following Repair of Aortopulmonary Window in Infancy

Paramjeet S. Chopra MD1; William H. Reed MD1; Allen D. Wilson MD2; and P. Syamasundar Rao MD2

1 From the Department of Surgery, Division of Cardiovascular Surgery, University of Wisconsin Medical School, Madison
2 From the Department of Pediatrics, Division of Pediatric Cardiology, University of Wisconsin Medical School, Madison

Anomalous origin of the circumflex coronary artery is extremely rare and may cause serious perioperative myocardial injury associated with correction of coexisting congenital malformations. We describe a 15-year-old female patient who underwent surgical correction of an aortopulmonary window at 13 months. Fourteen years later, she presented with dyspnea on exertion associated with angina. On cardiac catheterization, she was noted to have a step-up in oxygen saturation in the pulmonary artery and retrograde filling of the circumflex coronary artery from the left anterior descending coronary artery, with drainage into the pulmonary artery. The patient underwent surgical bypass of the anomalous circumflex coronary artery and ligation of its anomalous origin in the pulmonary artery. Her postoperative course was uneventful, with complete relief of symptoms. We have reviewed this rare congenital anomaly and its therapeutic options.

Key Words: anomalous origin of left coronary artery • aortopulmonary window • coronary steal




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