Anomalous left coronary artery from the pulmonary artery (ALCAPA)

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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