Third Delivery in a Chinese Patient With Anomalous Origin of Left Coronary Artery From Pulmonary Artery (ALCAPA): A...

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital defect that poses a significant risk of myocardial ischemia and sudden death, especially during the hemodynamic stresses of pregnancy. Although surgical correction is standard, the management of asymptomatic adult-type ALCAPA diagnosed during pregnancy remains a high-stakes clinical challenge.

We report the case of a 36-year-old multiparous woman with incidentally diagnosed adult-type ALCAPA during her third pregnancy. Serial echocardiography revealed moderate mitral regurgitation. The pregnancy was complicated by superimposed preeclampsia at 33 weeks. A dedicated multidisciplinary team implemented a tailored plan for labor induction at 37 weeks in a hybrid operating room, employing epidural analgesia and continuous hemodynamic monitoring. The patient underwent a successful vaginal delivery of a healthy infant. Intriguingly, mitral regurgitation transiently worsened to severe on postpartum Day 3 but significantly improved to mild by Day 7, correlating with resolution of the pregnancy-induced volume load. Coronary CTA postpartum confirmed the diagnosis.

Multidisciplinary planning enables safe vaginal delivery in select ALCAPA pregnancies. Dynamic peripartum changes in mitral regurgitation underline the role of volume shifts and the need for serial echocardiography to guide management and time definitive surgery.