ALCAPA Diagnosed in an Elderly Patient

Anomalous left coronary artery origin arising from the pulmonary artery (ALCAPA) occurs in less than 0.01% of the general population, with symptoms often manifesting within the first 3 months of life. Without surgical repair, early mortality is the most common outcome.

Here, we present the case of a 66-year-old woman who was found to have previously undiagnosed ALCAPA. Our patient did not undergo surgical management and instead became asymptomatic with medical management alone, in part owing to substantial collaterals and a dilated right coronary artery.

In rare circumstances, patients with ALCAPA have been known to survive into adulthood without surgical intervention. For patients with ALCAPA presenting in adulthood, surgical intervention must be considered in the setting of symptoms, medical therapy, and surgical risk; conservative therapy may be the most appropriate approach in certain patients.