Anomalous left coronary artery from main pulmonary artery - A case report

Anomalous left coronary artery from pulmonary artery (ALCAPA) is a rare congenital coronary artery malformation. Left uncorrected, nearly 90% of patients will die within one year. The clinical presentation of ALCAPA is variable during infancy and can mimic common conditions such as infantile colic, gastro-esophageal reflux disease, food intolerance and respiratory infections. Without surgical repair, surviving patients are subjected to risks of myocardial ischemia with global cardiomyopathy, chronic mitral regurgitation, and sudden death. However, in some cases collateral blood supply from the right coronary artery is sufficient and symptoms may be subtle or even absent. With early surgical correction the prognosis is good, but awareness of this condition is essential for prompt diagnosis and referral to a tertiary cardiac centre. We present the unusual case of a 13 year old asymptomatic boy who was referred to the tertiary healthcare centre for investigation of incidentally detected murmur during school health check which was later found to be resulting from previously undiagnosed anomalous left coronary artery arising from the pulmonary artery (ALCAPA) with preserved left ventricular function. This case stresses the need for high index of awareness among paediatricians and general practitioners regarding this entity so as to enable early detection and therapeutic intervention with improved prognosis for these children.