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The authors studied a series of 100 patients submitted to direct myocardial revascularization before 40 years of age. One hundred and seventy-three saphenous vein by-passes and 4 mammary artery left descending coronary artery anastomoses were performed. There was no operative mortality and the late mortality was 2%. The period of postoperative clinical evaluation of the patients varied from 12 to 60 months (mean 32.0 months).

The authors present a case of a 24-year-old woman with anomalous left coronary artery originating from the pulmonary artery. Surgical correction was performed by the direct transposition of the anomalous left coronary artery from the pulmonary artery to the ascending aorta, without interposed graft. Pre- and postoperative evaluations, including angiograms and cycloergometer stress test are presented. The advantages of this technique are discussed, emphasizing the creation of a two-coronary system without the use of prosthetic, arterial or venous grafts. In the present case the left coronary artery originated from the right posterior sinus of the pulmonary artery. The patient is doing well 23 months after operation.