Late adult presentation of anomalous left coronary artery from the pulmonary artery syndrome: A rare case report

ABSTRACT

An anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare but fatal congenital cardiovascular disease. In this condition, the left coronary artery originates from the pulmonary artery, whereas it should normally originate from the ascending aorta. This causes left ventricular dysfunction/insufficiency. It is asymptomatic in many cases and is missed during the initial months of life. Incidence is 1 in 300,000 live births and comprises about 0.25%–0.5% of congenital heart disease. In this article, we present the case of a 56-year-old adult who came with complaints of chest pain and exertional dyspnea. Systemic examination was normal. Electrocardiogram findings showed a left bundle branch block pattern. A transthoracic echocardiogram showed Left ventricular (LV) dysfunction along with papillary muscle echo bright due to infarction which made a suspicion of ALCAPA and was later confirmed by coronary angiography. ALCAPA is a clinical diagnostic challenge as it presents with similar complaints of common pediatric diseases such as bronchiolitis, failure to thrive, and cardiomyopathy. Usually, the majority of affected children remain undiagnosed and die within the 1 ^st year of life, and only a few survive till adulthood; hence, it is of utmost importance to keep a watch for this condition for early diagnosis and surgical intervention, which will help in improving the prognosis.