Anomalous left coronary artery from the pulmonary artery (ALCAPA)

Case contributed by Dr Annette Johnstone

Presentation

Chest pain and shortness of breath on exertion.

Patient Data

Age: 30 years
Gender: Female

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.

Case Discussion

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

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