Severe left ventricular dilatation and mitral regurgitation secondary to ALCAPA in childhood: a case report

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect, with an estimated incidence of 1 in 300,000 live births and a mortality rate approaching 90% within the first year of life if left untreated. We present the case of a three-year-old boy with progressive dyspnea, paroxysmal tachycardia, and poor weight gain, initially diagnosed with severe left ventricular dilatation and severe mitral regurgitation. Transthoracic echocardiography and cardiac computed tomography angiography confirmed the diagnosis of ALCAPA. Surgical correction included left coronary artery reimplantation and mitral valve repair. The patient was discharged without complications. At a two-year follow-up, he remained asymptomatic, with preserved left ventricular function and mild mitral regurgitation. This case highlights the importance of advanced imaging in the diagnosis and the role of surgical intervention in improving outcomes in this potentially fatal condition.