Anomalous left coronary artery arising from the pulmonary artery (ALCAPA)

Case contributed by Dr Craig Hacking


Worsening chronic SOB

Patient Data

Age: 30
Gender: Female

Coronary arteries

The left main coronary artery (LMCA) arises from the main pulmonary trunk. LCx and the LAD arise from the LMCA. The patient has a large RCA which is supplying the LAD via multiple collaterals. Retrograde flow demonstrated from the LAD into the main pulmonary trunk (seen on other phases not shown). A small ramus intermedius artery arises directly from the LMCA. No significant stenosis identified.

Cardiac findings

Dual lead PPM noted. Marked dilatation of the right ventricle and left atrium. Mild subendocardial fatty metaplasia within the left ventricle and mural calcification suggests previous ischaemia.

Extracardiac findings

Small right pleural effusion.


Anomalous left coronary artery arising from the pulmonary artery (ALCAPA) with evidence of reversal of flow from the left main coronary artery into the main pulmonary trunk.

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Case information

rID: 37167
Published: 2nd Jun 2015
Last edited: 11th Aug 2017
System: Cardiac
Inclusion in quiz mode: Included

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