Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is an extremely rare congenital cardiac anomaly with the incidence of 0.25% - 0.5% of all congenital heart diseases in the United States. ALCAPA, in rare incidences, has been described occurring with other congenital cardiac defects.
This is a case of 43 year old female, known case of Patent Ductus Arteriosus, S/p ligation at 30 years of age, who came in with symptoms of easy fatigability accompanied by dyspnea and chest pain for 3 months. Patient was subsequently admitted and underwent closure of ALCAPA with coronary artery bypass graft (left internal mammary artery to left anterior descending artery). Intraoperative findings were a left coronary artery ostia draining into the main pulmonary artery and a dilated right coronary artery with collaterals. Post-operative recovery was uneventful and patient was discharged asymptomatic.
ALCAPA is a rare congenital anomaly which can occur with a PDA. Symptoms of ALCAPA present during the 1st 2 months of life in 85% of cases but may also manifest later in childhood.