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

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 suggest previous ischemia.

Extracardiac findings

Small right pleural effusion.

Conclusion

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.