Anomalous origin of left main coronary artery from pulmonary artery in an adult: Peri-operative concerns

Anomalous origin of the left coronary artery from the pulmonary artery is an infrequent and lethal anomaly which can be alleviated surgically. However, its timely diagnosis is important. The management of such patients is challenging for cardiac surgeons and anesthesiologists as they are vulnerable to myocardial ischemia from coronary steal, left ventricular dysfunction, dysrhythmias and pulmonary hypertension. In this report, we present an adult patient who underwent successful surgery for this anomaly. Clinical presentation, diagnosis and anesthetic management of such patients is discussed. © 2010 Indian Association of Cardiovascular-Thoracic Surgeons.