Left main coronary artery arising from the right pulmonary artery

Case contributed by Stefan Tigges


Shortness of breath.

Patient Data

Age: 50 years.
Gender: Male


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.

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. 

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