Management of anomalous origin of the left coronary artery from the pulmonary artery in an adult with ischemic cardiomyopathy and pulmonary hypertension.

Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital anomaly that usually presents in infancy with cardiomyopathy and congestive heart failure. Surgical reimplantation of the anomalous left coronary artery is offered as definitive treatment in infancy. We describe the case of a 26-yearold man presenting with cardiomyopathy who was identified to have an anomalous left coronary artery from the pulmonary artery. Surgical reimplantation presented a high risk due to severe postcapillary pulmonary hypertension. Transcatheter occlusion of the proximal left main coronary artery was obtained. The patient was started subsequently on anticongestive therapy. Surgical coronary artery bypass was performed 3-months later after resolution of postcapillary pulmonary hypertension. The patient remains well at 1-year follow-up. (C) 2014 by The Society of Thoracic Surgeons