Direct Measurement of Instantaneous Coronary Blood Flow after Total Correction of Anomalous Left Coronary Artery

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Abstract
An anomalous left coronary artery was excised from the pulmonary artery and connected by a reversed segment of autogenous saphenous vein to the ascending aorta in a 20-year-old man. Before it was anastomosed to the aorta, retrograde flow of oxygenated blood from coronary artery to pulmonary artery occurred predominantly during diastole; the pressure in the left main coronary artery was 30/15 mm Hg and rose to systemic levels following occlusion of the coronary artery at its junction with the pulmonary artery. After transplantation to the aorta, the vessel was encircled with an electromagnetic flow probe and instantaneous left coronary artery blood flow was measured simultaneously with the pressures in the left ventricle and ascending aorta. The pattern of instantaneous coronary blood flow and its relation to ventricular and aortic pressure were similar to the pattern that has been observed in normal animals. Mean flow through the left coronary artery was 104 ml/min. Following operation, the left ventricular enddiastolic pressure decreased to normal levels and the anastomosis was proved to be patent. Transplantation of the anomalous coronary artery to the systemic circulation restores normal coronary dynamics and may be preferable to simple ligation.

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