Anomalous origin of the left coronary artery from the pulmonary artery: successful direct reimplantation in a 50-year-old man.

Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital coronary artery anomaly that is often referred to as Bland White Garland syndrome. Most patients with this anomaly require surgical intervention early in life, and it is extremely rare that patients reach middle age without any symptoms. We present a 50-year-old man with this anomaly, who underwent direct reimplantation of the left main coronary trunk to the ascending aorta. His postoperative course was uneventful, and three and a half years after the operation, he is well and does not require medication. Several surgical procedures can be used to treat this anomaly, but we prefer to use direct reimplantation, whenever technically possible. To our knowledge, this patient is the oldest patient to have undergone a direct reimplantation without any angioplasty.