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Unilateral agenesis of the pulmonary artery is a rare congenital anomaly, which commonly involves the right side. Cases are associated with systemic collaterals, that may also arise from the coronary arteries. Two adult patients are presented with exertional dyspnea. Investigations revealed a right pulmonary artery agenesis associated with collaterals from right coronary artery. The implication of such an anomaly was different among both patients due to associated systemic collaterals and congenital heart lesions. Both patients were treated medically to control pulmonary artery pressure. Adult patients with pulmonary artery agenesis have variable presentations and hemodynamic conditions. The presence of associated congenital heart disease and extensive systemic collaterals play a major role in hemodynamics. The association of coronary collaterals is rare and its implication varies from no effect to ischemic manifestations and myocardial infarction.

Summary Introduction: The functional significance of coronary artery collateral (CAC) vasculature in humans has been debated for decades and this has been compounded by the lack of a standard, systematic, objective method of grading and documenting CAC flow in man. CACs serve as alternative conduits for blood in obstructive coronary artery disease. This study aimed to evaluate the impact of CACs on left ventricular function in the presence of total coronary arterial occlusion. Methods: The study group included the coronary angiographic records of 97 patients (mean age: 59 ± 8 years). CACs were graded from 0–3 based on the collateral connection between the donor and recipient arteries. Left ventricular function was computed from the ventriculogram and expressed as ejection fraction (EF). Results: The mean EF of the patients with grades 0, 1, 2 and 3 CACs were calculated as 50.4, 47, 60.5 and 70%, respectively. A significant difference was recorded in the mean EF calculated for the different CAC grades (p = 0.001). There was a significant positive correlation (p < 0.001; r = 0.478) between the mean EF and the CAC grades. Conclusion: The patients with better coronary collateral grades had a higher mean EF. Therefore, as the grade of CACs increased, there was an improvement in their ability to preserve left ventricular function.

After hearing a lecture I gave on chronic stable angina, a friend of mine and fellow cardiologist from Florida, Steven Shang, MD, approached me to discuss the relevance of coronary artery collateral blood flow. Copyright © 2010 Wiley Periodicals, Inc.

[Figure][1] [![Graphic][3] ][3] A 6-year-old female with tetralogy of Fallot whose echocardiogram and cardiac catheterization showed pulmonary atresia, ventricular septal defect, aortopulmonary collaterals, and collaterals from the coronary arteries to the main pulmonary artery.

Two hundred and twelve patients with recognizable coronary artery block and no other pathology were selected using an interactive computer data retrieval system. The relationship of coronary artery collaterals to left ventricular (LV) dysfunction was investigated. Analysis revealed the significant role of the left anterior descending (LAD) coronary artery and collateral development to the preservation of LV function. This study underlines the value of radiological observation when subject to statistical scrutiny.