A rare case of anomalous left coronary artery from the pulmonary artery (ALCAPA) presenting congestive heart failure in an adult

A 41-year-old woman with no modifiable coronary risk factors presented with a progressive exertional dyspnea. Chest radiography showed an enlarged cardiac silhouette with reinforced pulmonary vasculature in bilateral lower lung fields and both pleural effusion. Echocardiography revealed a dilated, globally hypokinetic left ventricle with an ejection fraction of 40%. Multislice cardiac computed tomography revealed abnormal origin of LCA from the main pulmonary artery receiving collaterals from a normally originating dilated tortuous right coronary artery. Coronary angiography revealed a single, large, and tortuous RCA arising from the right sinus of Valsalva and giving off extensive collateral vessels coursing over the right ventricular wall, the interventricular septum, and the apex to the left coronary artery that was drained into the proximal main pulmonary. The diagnosis of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) was confirmed. The patient underwent successful reimplantation of LCA to aorta after closure of the ostium (in the main pulmonary artery) of the anomalously originating LCA. After surgical and medical treatment, the patient's symptoms were relieved and both pleural effusions were improved on chest radiography. After then, the patient was discharged on medication.