Asymptomatic case of anomalous left coronary artery originating from pulmonary artery-An incidental diagnosis

Abstract

Background and Objective: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare but well-described cardiac anomaly with a frequency of 0.25 - 0.5% among all cardiac anomalies. It is associated with a high mortality rate (90%) in infants (within 1 year of birth) due to inadequate collateral circulation development. However, if good collateral circulation to the left side of the heart is established, the patient may survive into adulthood without complications. Case report: The present report describes an unusual case of a 14-year-old boy who was incidentally diagnosed with ALCAPA and was completely asymptomatic with normal left ventricular ejection fraction. The patient was treated with conservative medical therapy and recommended for regular clinical follow-up. Conclusion: Although our patient’s parents were not convinced about surgical repair, he could be further treated with conservative medical therapy. However, surgical repair should be performed in all cases of ALCAPA to prevent the progression of ischemia, arrhythmia, congestive heart failure, and even sudden death.