Thallium—201 Scintigraphy After Surgical Repair of Hemodynamically Significant Primary Coronary Artery Anomalies

doi:10.1378/chest.81.6.687

Chest

Volume 81, Issue 6, June 1982, Pages 687-692

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Nine patients with hemodynamically significant congenital coronary artery anomalies underwent surgical repair at our institution during the period 1960 to 1979. Four received diagnoses of anomalous left coronary artery arising from the pulmonary artery, while five patients had coronary artery fistulae. Stress ²⁰¹Tl scintigraphy was performed on these patients 0.5 to 18 years after surgical correction as a means of assessing the adequacy of myocardial perfusion. No perfusion defects were visualized on any of the thallium studies. The surgical procedure used did not appear to influence the results of ²⁰¹Tl stress imaging. Thus, these nine patients with surgically corrected primary coronary artery anomalies had no evidence of ischemia as assessed by stress thallium scintigraphy. Serial preoperative and postoperative thallium studies are now indicated to determine the role of this procedure in the management of hemodynamically significant congenital coronary artery anomalies.

Section snippets

Patient Population

Nine patients with hemodynamically significant congenital coronary artery anomalies, who underwent surgical repair at Walter Reed Army Medical Center, comprised the study group. Their clinical characteristics at the time of operative repair are detailed in Table 1. Five patients were females and four were males. Their ages ranged from 3 to 49 years with a mean of 14.3 years. Continuous murmurs were heard in six patients, while the murmur of mitral insufficiency was heard in four. One patient

RESULTS

At the time of scintigraphy, the patients' ages ranged from 11.5 to 61 years, with a mean of 22.9 years. The mean duration from surgical repair to thallium study was 8.6 years, with a range from 0.5 to 18 years (Table 3). All patients were asymptomatic postoperatively at the time of thallium scintigraphy. The four patients with an anomalous left coronary artery had no residual murmurs after surgical repair. No continuous murmurs were present postoperatively in the group with coronary artery

DISCUSSION

Hemodynamically significant congenital anomalies of the coronary arteries have been reported to result in myocardial ischemia and infarction.1, 2, 3, 4, 5 Until recently, reliable methods of assessing regional myocardial perfusion noninvasively have not been available. Scintigraphy with ²⁰¹Tl was used in this study to evaluate the presence of myocardial ischemia in congenital coronary artery anomalies after surgical repair.

Four of the patients in this study underwent surgical correction of an

REFERENCES (33)

HN Oldham et al.
Surgical management of congenital coronary artery fistula
Ann Thorac Surg
(1971)
NS Talner et al.
Anomalous origin of the left coronary artery from the pulmonary artery
Am J Cardiol
(1965)
B Pitt et al.
Myocardial perfusion imaging and gated cardiac blood pool scanning: clinical application
Am J Cardiol
(1976)
JP Finley et al.
Thallium-201 myocardial imaging in anomalous left coronary artery arising from the pulmonary artery: applications before and after medical surgical treatment
Am J Cardiol
(1978)
NL Wright et al.
Coronary artery steal due to an anomalous left coronary artery originating from the pulmonary artery
J Thorac Cardiovasc Surg
(1970)
DA Cooley et al.
Definitive surgical treatment of anomalous origin of left coronary artery from pulmonary artery: indications and results
J Thorac Cardiovasc Surg
(1966)
WW Pinsky et al.
Anomalous left coronary artery: report of two cases
J Thorac Cardiovasc Surg
(1973)
CL Anthony et al.
Spontaneous graft closure in anomalous origin of the left coronary artery
Chest
(1975)
DC Levin et al.
Hemodynamically significant primary anomalies of the coronary arteries
Circulation
(1978)
B Koops et al.
Congenital coronary artery anomalies: experience at Stanford University Hospital (1963-1971)
JAMA
(1973)

JJ McNamara et al.

Congenital coronary artery fistula

Surgery

(1969)

H Eie et al.

Arterio-venous fistulae of the coronary arteries

Scand J Thorac Cardiovasc Surg

(1971)

AS Nadas et al.

Anomalous left coronary artery originating from the pulmonary artery: report of two surgically treated cases with a proposal of hemodynamic and therapeutic classification

Circulation

(1964)

H Wesselhoeft et al.

Anomalous origin of the left coronary artery from the pulmonary trunk: its clinical spectrum, pathology, and pathophysiology, based on a review of 140 cases with seven further cases

Circulation

(1968)

LW Perry et al.

Anomalous left coronary artery from pulmonary artery: report of 11 cases; review of indications for and results of surgery

Circulation

(1970)

J Askenazi et al.

Anomalous left coronary originating from the pulmonary artery: report on 15 cases

Circulation

(1975)

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In most instances of anomalous left coronary artery originating from the pulmonary artery, surgical treatment is recommended. Because establishment of a direct systemic to coronary blood flow is expected to provide the best recovery of left ventricular function, various corrective procedures have been proposed. Subclavian-left coronary artery anastomosis appears to be a logical approach. Four patients operated on at Sainte-Justine Hospital, at an average age of 33 months (27 to 44), with an end-to-end subclavian-left coronary artery anastomosis were evaluated 6 to 46 months postoperatively. The anastomosis was patent in all cases. End-diastolic volume index (74.6 ± 24.7 versus 122.7 ± 15.3 ml/m²) and ejection fraction (0.58 ± 0.07 versus 0.33 ± 0.06) were improved significantly. Subclavianleft coronary artery anastomosis appears to meet the main criteria for an optimal physiologic correction of anomalous left coronary artery: restoration of a two-coronary artery system, improvement of left ventricular function, and likelihood of long-term patency.
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Anomalous origin of the left coronary arterial tree through three stems - one from the pulmonary trunk
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In an 18-year-old asymptomatic male athlete, the left anterior descending coronary artery was found to arise from the pulmonary trunk. The remainder of the left coronary arterial tree arose through two stems from the aorta. Collateral retrograde filling of the left anterior descending coronary artery from the right coronary artery and the left circumflex coronary artery was demonstrated, but we found no evidence of left-to-right shunting into the pulmonary trunk. The patient has chosen conservative treatment, thus offering an unusual opportunity to follow the natural course of this lesion, which may increase understanding of its natural history.
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: Presented in part at the American Heart Association 52nd Scientific Sessions, Anaheim, November 12-15, 1979.

Manuscript received July 13; revision accepted October 16.

The opinions and/or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense

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Chest

Clinical InvestigationsThallium—201 Scintigraphy After Surgical Repair of Hemodynamically Significant Primary Coronary Artery Anomalies

Section snippets

Patient Population

RESULTS

DISCUSSION

Ann Thorac Surg

Am J Cardiol

Am J Cardiol

Am J Cardiol

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Chest

Hemodynamically significant primary anomalies of the coronary arteries

Circulation

Congenital coronary artery anomalies: experience at Stanford University Hospital (1963-1971)

JAMA

Congenital coronary artery fistula

Surgery

Arterio-venous fistulae of the coronary arteries

Scand J Thorac Cardiovasc Surg

Anomalous left coronary artery originating from the pulmonary artery: report of two surgically treated cases with a proposal of hemodynamic and therapeutic classification

Circulation

Anomalous origin of the left coronary artery from the pulmonary trunk: its clinical spectrum, pathology, and pathophysiology, based on a review of 140 cases with seven further cases

Circulation

Anomalous left coronary artery from pulmonary artery: report of 11 cases; review of indications for and results of surgery

Circulation

Anomalous left coronary originating from the pulmonary artery: report on 15 cases

Circulation

Clinical Investigations
Thallium—201 Scintigraphy After Surgical Repair of Hemodynamically Significant Primary Coronary Artery Anomalies