Presentation
Shortness of breath.
Patient Data
Normal.
The left main coronary artery arises from the right pulmonary artery. The left main, right and circumflex coronary arteries are normal in course and caliber. The proximal LAD is occluded and contains calcified plaque. The mid and distal LAD opacify normally, suggesting retrograde filling of the LAD from collaterals. Right dominant system, dilated left ventricle.
Hypokinetic severely dilated left ventricle (ejection fraction 15%) with mild mitral regurgitation.
Normal v abnormal origins
Diagrammatic comparison of normal coronary origins and abnormal origins from the pulmonary artery. In this case, the left coronary had an abnormal origin, a diagram of anomalous right coronary artery from the pulmonary artery (ARPACA) is included for comparison.
Case Discussion
Anomalous left coronary artery origin from the pulmonary artery (ALCAPA) is an extremely rare but devastating coronary anomaly.
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