Anomalous left coronary artery from the pulmonary artery: A rare case diagnosed in an adult

ALCAPA syndrome (anomalous origin of left coronary artery from the pulmonary artery) is an extremely rare congenital cardiac anomaly associated with high mortality rate at young age. If undiagnosed and uncorrected, the affected individuals rarely survive beyond infancy. This article reports on a 45-year-old asymptomatic man with the ALCAPA diagnosed thanks to a detailed cardiac examination, that followed the finding of the left bundle branch block and a decreased left ventricular systolic ejection fraction. Although coronary angiography and computed tomography are considered to be the key diagnostic methods for ALCAPA, in this case the diagnosis was established based on echocardiography. Previously, the patient has been under regular review by a cardiologist with the incorrect diagnosis of multiple ventricular septal defects. In fact, this diagnosis resulted from a misinterpretation of the ultrasound image of the intercoronary connections. The presence of a separate diagonal artery originating from aorta renders this case report even more interesting.