Adult-type ALCAPA: missed at preoperative evaluation

Area of Science:

• Cardiology
• Congenital Heart Disease

Background:

• Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) syndrome is a rare congenital cardiac anomaly.
• It typically presents in infancy and is associated with high mortality if untreated.

Observation:

• A 43-year-old female with undiagnosed adult-type ALCAPA underwent mitral valve surgery for severe mitral regurgitation.
• Intraoperative findings revealed a dilated right coronary artery and absence of the left coronary ostium.

Findings:

• The patient was diagnosed with adult-type ALCAPA, a rare presentation of this congenital anomaly.
• Surgical correction using a modified Cabrol graft was successfully performed due to anatomical constraints.

Implications:

• This case underscores the importance of considering ALCAPA in adult patients presenting with cardiac issues, even after initial surgery.
• Timely diagnosis and surgical intervention are crucial for managing ALCAPA and improving patient outcomes.