Anomalous left coronary artery from the pulmonary artery (ALCAPA)
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Chest pain and shortness of breath on exertion.
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Anomalous left coronary artery vessel originating from the main pulmonary artery. A very small caliber left main stem (LM) can be seen, with marked collateral vessels.
ALCAPA can present in two ways:
- infantile - no collaterals, RCA and LAD are normal caliber. This can lead to ischemic cardiomyopathy secondary to infarction
- adult - retrograde flow collaterals from RCA to LAD with dilatation from increased flow. This can lead to chronic myocardial ischemia, arrhythmia and sudden death