An asymptomatic 8-year-old girl with no medical history was referred for a heart murmur. Echocardiography demonstrated normal left ventricular function with an ejection fraction of 67% and revealed a to-and-fro Doppler signal suggesting a coronary artery fistula. However, cardiac angiography suggested an anomalous origin of a coronary artery. Subsequent CT using three-dimensional computer graphic software (Viewtify®, SCIEMENT) confirmed an anomalous origin of the left anterior descending coronary artery from the pulmonary artery (Figure 1). Scintigraphy and exercise stress tests showed no evidence of myocardial ischaemia.

Figure 1.

Preoperative CT using three-dimensional computer graphic software (Viewtify®, SCIEMENT). MPA = main pulmonary artery; LAD = left anterior descending artery.

Considering the future risk of angina and sudden death, surgical correction was performed. On opening the pericardium, there was a tortuous right coronary artery (Figure 2). The left anterior descending artery orifice was identified in the posterior-facing sinus; however, it arose from the lateral aspect of the pulmonary trunk, as seen in preoperative imaging (Figure 1). Using the spiral cuff technique, ^{Reference Ando, Kado and Masuda1} the left anterior descending artery was extended with the pulmonary artery wall strip and anastomosed to the aortic wall just above the left circumflex artery origin (Figure 3a and 3b). Postoperative imaging revealed the successful reimplantation of the left anterior descending artery behind the pulmonary trunk (Figure 4a and 4b).

Figure 2.

Intraoperative photographs showed a tortuous right coronary artery. RCA = right coronary artery.

Figure 3.

The left anterior descending artery was extended using the spiral cuff technique and directly anastomosed to the aortic wall. MPA = main pulmonary artery; LAD = left anterior descending artery.

Figure 4.

Postoperative CT using Viewtify® showed a well-reimplanted left anterior descending artery behind the pulmonary trunk. MPA = main pulmonary artery; LAD = left anterior descending artery; LCX = left circumflex artery; RPA = right pulmonary artery; LPA = left pulmonary artery.

Anomalous origin of the left anterior descending coronary artery from the pulmonary artery is rare and has an incidence of 0.06% among coronary artery anomalies. Given the limited number of surgical reports and anatomical complexity, appropriate three-dimensional imaging provides an accurate interpretation of anomalous coronary arteries and related anatomy, which is useful for optimal surgical planning.