Anomalous origin of the left coronary artery from pulmonary artery a late presentation—Case report and review of literature

AbstractAn otherwise healthy 26-year-old female presented with sudden cardiac arrest. She was resuscitated with unsynchronized cardioversion for ventricular fibrillation. A left heart cardiac catheterization showed anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Cardiac computed tomographic angiography confirmed this abnormality. She underwent direct translocation of the left main coronary artery to the aorta, and after a stormy postoperative course was discharged home.ALCAPA is a rare congenital abnormality of the coronary system that is associated with early infant mortality and adult sudden death. The use of advanced cardiac imaging has resulted in an increase in the number of diagnosed ALCAPA cases, especially in the adult population, sometimes even in the asymptomatic. The extent of collateral circulation that develops between the right coronary artery and the left coronary artery determines the outcome; the more collateral circulation there is, the less the hypoxic damage to the ventricle. This not only informs us that people survive ALCAPA into adulthood but also highlights the importance for adult cardiologists to be aware of this interesting disease. Corrective surgery remains the treatment of choice. We present a rare case of ALCAPA, with first presentation in adulthood in the form of a malignant ventricular arrhythmia.<Learning objective: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital abnormality of the coronary system that is associated with early infant mortality and adult sudden death. Hence we feel it is most important to be aware of this entity, especially as the incidence of diagnosed ALCAPA is on the rise in adulthood. Also the images provided and the discussion have high educational value for generalists and cardiologists alike.