Surgical repair of anomalous origin of the coronary artery from the pulmonary artery in children.

OBJECTIVE: To evaluate surgical management of children with coronary artery anomalies, including patients with rare abnormalities (left anterior descending artery or right coronary artery originating from the pulmonary artery). METHODS: A retrospective review of eight patients (aged 2 months--10 yr; median 3.5 yr), treated for coronary artery anomalies between 1989 and 1999. Coronary vessels were reimplanted to the aorta in four children, while the remaining four were subjected to the Takeuchi procedure. RESULTS: All children survived. None required mechanical circulatory support. In six patients significant mitral valve insufficiency developed, nevertheless, no intraoperative mitral valvuloplasty was performed. Follow-up was 2 months--10 yr. All patients developed normally and are currently in NYHA class I. Echocardiography revealed normal FS and EF values within 1--17 months postoperatively. CONCLUSIONS: In children with coronary artery anomalies, the best results are achieved with an early diagnosis and aggressive management. In our opinion coronary vessel reimplantation and the Takeuchi procedure yields comparable results.