[Anomalous coronary drainage from the pulmonary artery with associated heart and vascular abnormalities. Report on 3 patients and review of the literature].

The clinical and cineangiocardiographic findings of three children with anomalous coronary artery origin were analyzed: in the first case, associated with Scimitar syndrome, the left coronary artery arose from the left posterior pulmonary sinus; in the second case, in addition to Fallot's tetralogy, the left coronary artery had its origin from the right pulmonary artery; and in the third case, the left circumflex artery arose anomalously from the right pulmonary artery in association with coarctation of the aorta, aortic valve stenosis and diverticulum of the left ventricle. The findings of 46 cases reported in the literature to have anomalous origin of one or both coronary arteries, a single coronary artery, or of the left anterior descending coronary artery reveal that additional cardiovascular anomalies can also be found in 4 to 17% of the cases described in collectives of more than ten patients. Almost any type of cardiovascular malformation can coexist with anomalous origin of a coronary artery from the pulmonary artery. There seems to be a preponderance of conotruncal malformations accounting for 33%, whereas their incidence among all congenital heart defects is 15%. The effect of the hemodynamics of the associated malformation can exert can influence on the natural history of the disease and, experience indicates that the coronary anomaly may be masked by the signs and symptoms of the associated cardiovascular malformation. Accordingly, to exclude such anomalies, preoperative studies should include assessment of the coronary arteries. To establish the diagnosis of anomalous origin of a coronary artery from the pulmonary artery, in addition to an injection of contrast medium into the main pulmonary artery, an aortic root injection is adequate in the majority of patients and, in general, selective coronary arteriography is not required.