Presentation of Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery with Left Sided Coronary Ostium in an Adult Patient

An anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary anomaly. It usually presents in infancy with intractable left sided heart failure. Most patients die in infancy, but survival into adulthood is possible. Patients may complain of dyspnea, syncope or effort angina. They may remain asymptomatic; or experience sudden death after exercise. A 56-year-old woman presented with a twomonth history of exertional chest discomfort. Echocardiography showed a coronary anomaly with preserved systolic function and no resting regional wall motion abnormality. The coronary and CT (computed tomography) angiography studies revealed the anomalous origin of the left coronary artery. A review of ALCAPAstudies is presented along with images from the echocardiogram, coronary angiogram and CT scan performed for this case.