Anomalous Coronary Artery Arising From the PA Recommendations for Anomalous Coronary Artery Arising From the PA Referenced studies that support recommendations are summarized in Online Data Supplement 51. COR LOE Recommendations Therapeutic I B-NR Surgery is recommended for anomalous left coronary artery from the PA.S4.4.7.3-1 S4.4.7.3-7 I C-EO In a symptomatic adult with anomalous right coronary artery from the PA with symptoms attributed to the anomalous coronary, surgery is recommended. IIa C-EO Surgery for anomalous right coronary artery from the PA is reasonable in an asymptomatic adult with ventricular dysfunction or with myocardial ischemia attributed to anomalous right coronary artery from the PA. CLINICAL STATEMENTS AND GUIDELINES Recommendation-Specific Supportive Text 1. Surgery can include reimplantation of the left coronary artery directly into the aorta with or without an interposition graft. Ligation or clo- sure of the left coronary artery at the level of the PA with coronary artery bypass grafting can also be performed, usually using the left internal mammary artery anastomosed to the left anterior descending. 2. Surgery can include reimplantation of the right coronary artery directly into the aorta with or without an interposition graft. Ligation or clo- sure of the right coronary artery at the level of the PA with coronary artery bypass grafting can also be performed, usually using the right internal mammary artery anastomosed to the right coro- nary or posterior descending coronary artery. 3. Surgery to alleviate ischemia or ventricular dys- function is reasonable if the anomalous coronary artery is thought to be the cause. Surgery can in- clude reimplantation of the right coronary artery directly into the aorta with or without an interpo- sition graft. 