A surgical treatment proposed for either endocardial fibroelastosis or anomalous left coronary artery

A new surgical approach is suggested for the treatment of endocardial fibroelastosis and anomalous left coronary artery. The recommended procedure (poudrage) has been shown in some cases to produce an effective collateral circulation to the myocardium in patients with coronary heart disease. Four patients have been presented, 3 of whom have survived approximately 1 year with clinical improvement. During most of this time the patients have not been receiving digitalis. Of the 3 living patients, in 1 the diagnosis of anomalous left coronary artery is suggested on the basis of history of "anginal attacks" and electrocardiograms suggestive of anteroseptal myocardial infarction. The other 2 patients do not fulfill the criteria for anomalous left coronary artery but are clinically endocardial fibroelastosis. One patient died following surgery and necropsy failed to demonstrate any cause of death other than the underlying condition itself. The need for further follow-up is recognized. With utilization of this procedure in more patients the relative merits or faults may be brought out. However, it appears, that its use may be recommended in these conditions because they are statistically incompatible with life for any appreciable time and the procedure is relatively free of risk even in the case of diagnostic error.