The congenital coronary lesion most likely to cause death in infancy is:

B. Origin of the left coronary artery from the pulmonary artery

DISCUSSION: The prognosis for most patients with origin of the left coronary artery from the pulmonary artery is poor. It has been estimated that 95% of patients with this anomaly die within the first year of life unless surgical therapy is undertaken. Patients whose right coronary artery originates from the pulmonary artery are usually asymptomatic. Patients with coronary fistulas occasionally suffer congestive heart failure early. Congenital aneurysms of the coronary arteries are most often asymptomatic until complications occur, usually later in life.