Anomalous Origin of Left Coronary Artery from Pulmonary Artery [alcapa] –a Case Report

ALCAPA a rare congenital coronary anomaly, which usually manifests as an isolated defect, and can develop when there is an embryological failure of normal communication to the left coronary bud in the aorta, with an abnormal connection to the pulmonary bud instead. If left untreated, up to 90% of pediatric patients with this syndrome die within the 1st year of life. To survive beyond infancy, patients with ALCAPA syndrome develop significant collateral circulation from the right coronary artery(RCA) to the Left coronary artery(LCA) However, often it is not sufficient to supply the left ventricle, especially in the subendocardial region, manifesting as various degrees of the adult type of the disease. This study presents such a rare adult case, and its pathognesis, clinical spectrum, and findings are discussed. Management was successful, by placement of a Coronary artery bypass graft(CABG) with ligation of the anomalous LCA: the choice of procedures available & their implications are outlined.