Presentation
Shortness of breath.
Patient Data
Age: 50 years.
Gender: Male
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Frontal
Normal.
Axial C+ arterial phase
The left main coronary artery arises from the right pulmonary artery. The left main, right and circumflex coronary arteries are normal in course and caliber. The proximal LAD is occluded and contains calcified plaque. The mid and distal LAD opacify normally, suggesting retrograde filling of the LAD from collaterals. Right dominant system, dilated left ventricle.
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Four Chamber Steady state free precession
Hypokinetic severely dilated left ventricle (ejection fraction 15%) with mild mitral regurgitation.
Case Discussion
Anomalous left coronary artery origin from the pulmonary artery (ALCAPA) is an extremely rare but devastating coronary anomaly.