Anomalous origin of the left coronary artery from the pulmonary artery treated by palliative Vineberg operation in an infant.

Anomalous origin of the left coronary artery from the pulmonary artery was diagnosed in an infant girl who had evidence of transmural myocardial infarction of the free wall of the left ventricle. At age 13 months, she underwent a palliative left Vineberg implant, and remained asymptomatic until she was 8 years of age. At that time, she underwent suturing of the left coronary ostium for obliteration of the left coronary shunt at the pulmonary artery. At age 13, she underwent aortocoronary bypass to the left main coronary artery, with end-to-end anastomosis. The patient remains asymptomatic to date. We believe that this is the first reported case of a Vineberg operation performed in an infant for palliation of an anomalous left coronary artery originating from the pulmonary artery. This method allows time for the development of collateral circulation to the left coronary artery before definitive surgery is performed.

SURGICAL CORRECTION OF COMBINED DOUBLE-OUTLET RIGHT VENTRICLE AND TAUSSIG-BING SYNDROME.

Total surgical correction of a Taussig-Bing type double outlet right ventricle (DORV) was successfully performed in a severely cyanotic 3-year-old girl. The malformation was associated with bilateral conus, d-transposition of the great arteries, d-loop, and a subpulmonary ventricular septal defect (VSD) without significant pulmonary stenosis in situs solitus. It was impossible to create a tunnel repair by resecting the markedly hypertrophied muscular conus that separated the aortic valve from the subpulmonary ventricular septal defect. Therefore, the VSD was repaired with a Dacron patch, transforming the double outlet right ventricle into a transposition, after which total correction was achieved by means of a Mustard procedure.

SIGNIFICANCE OF ANGIOGRAPHIC ABSENCE OF LEFT ANTERIOR DESCENDING CORONARY ARTERY IN A LEFT VENTRICLE WITH INTACT ANTERIOR WALL.

Fifteen patients having total occlusion of the proximal left anterior descending coronary artery were studied. All fifteen had normal left ventricular anterior walls. The electrocardiogram was normal in eight patients; old inferior wall infarction was evident in one; anterior ischemia in five; and left anterior hemiblock in one. Collateral circulation was found in twelve patients (80%). These findings suggest that an angiographically non-visualized left anterior descending (LAD) vessel is patent and bypassable in patients where the anterior ventricular wall is intact, thus representing an additional criterion for aortocoronary bypass surgery.

A SECOND CASE OF LATE EMBOLIZATION OF PROSTHETIC MITRAL VALVE OCCLUDER WITH SURVIVAL FOLLOWING REOPERATION.

A 51-year-old male with acute fulminating pulmonary edema and cardiogenic shock secondary to severe mitral insufficiency from dislodgment of the disc occluder in a Wada-Cutter valve was treated by immediate open heart procedure with a Bjork-Shiley mitral valve replacement. The patient survived and remains well. This is the second patient reported to survive operation and replacement of a malfunctioning prosthetic mitral valve from which the poppet escaped and embolized. The first case was reported by Hughes et al(1) in February, 1975. Some striking similarities, as well as differences, in these two cases are discussed.