Evaluation of intramyocardial coronary flow velocity pattern before and after surgical repair of Bland-White-Garland syndrome by pulsed Doppler echocardiography]

Anomalous origin of the left main coronary artery from the pulmonary artery (Bland-White-Garland syndrome) is a rare congenital anomaly. Intramyocardial coronary flow dynamics by pulsed Doppler echocardiography were studied in three patients with this syndrome who underwent surgical repair by Hamilton's method. Before surgery, the intramyocardial flow at the ventricular septum showed a retrograde velocity pattern which had two peaks in systole and diastole in all patients. After surgery, two patients with successful repair showed a biphasic intramyocardial flow pattern which consisted of retrograde and antegrade flows in systole and diastole, respectively. In contrast, one patient who had a residual shunt between the left coronary artery and the pulmonary artery showed a biphasic pattern which had antegrade flow in systole and retrograde flow in diastole. These results may suggest that the evaluation of postoperative intramyocardial coronary flow velocity pattern by pulsed Doppler echocardiography is useful for detecting a residual shunt after surgical repair of Bland-White-Garland syndrome.