Anomalous left coronary artery from the pulmonary artery (ALCAPA) as a concealed cause of severe mitral regurgitation in children and adults: Case reports

INTRODUCTION: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary artery anomaly and is a concealed cause of mitral regurgitation. PRESENTATION OF CASE: We reported two cases of severe mitral regurgitation in whom the presence of ALCAPA was overlooked in the first cardiac surgery. In the first case, ALCAPA was diagnosed one year after the mitral annuloplasty and the surgical reimplantation was successfully performed. In the second case, ALCAPA was incidentally detected on multislice computerized tomography during preoperative workup for the second surgery to replace the dehiscent mitral prosthesis. DISCUSSION: The clinical presentation of ALCAPA varies highly. It is not difficult to diagnose an ALCAPA in newborns and infants. Contrarily, ALCAPA in children and adults can be overlooked. CONCLUSION: Physicians should always look for the presence of ALCAPA in patients who present with unexplained mitral regurgitation. The surgical strategy in patients with ALCAPA should be carefully individualised to achieve an optimal outcome and alleviate complications.