Anomalous Origin of Left Coronary Artery from The Pulmonary Artery of Left Main Coronary Artery (ALCAPA) In A Pediatric Patient: A Rare Case Report

Abstract

Background: The anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) is a rare congenital anomaly due to abnormal division of the conotruncus into the aorta and pulmonary artery or persistence of the pulmonary bud with involution of the aortic bud that forms the origin of the coronary artery on embryogenesis. Only a small portion of cases survive more than two months of age. The survived cases can appear as asymptomatic, symptomatic, sudden cardiac death of adulthood ALCAPA. Case Description: We present an 8-year-old boy with symptomatic adulthood type ALCAPA. Preliminary chest x-ray examination found cardiomegaly. Unspecific findings were found on Echocardiography including fistula right coronary artery (RCA) and left coronary artery (LCA), with mitral regurgitation, moderate tricuspid regurgitation, and cardiomyopathy. Catheterization confirmed the left coronary artery from the pulmonary artery (ALCAPA) of the left main coronary artery (LMCA) origin. Additional Cardiac computed tomography angiography (CTA) demonstrated the LM originates from the pulmonary trunk accompanied by the presence of collaterals between the RCA and LAD and dilatation and turbulence of the RCA. Conclusion: Early diagnosis and prompt surgical intervention can give excellent results and lead to gradual recovery.