Anomalous origin of left coronary artery from pulmonary artery (ALCAPA): A case report

Anomalous origin of left coronary artery from pulmonary artery (ALCAPA) also known as Bland-White-Garland Syndrome is a rare anomaly of coronary arteries comprising of 0.25%-0.5% of all congenital heart defects with a prevalence of 1 in every 300,000 live births. Its clinical significance lies in the possibility of resultant coronary steal phenomenon with a left-to-right shunt causing aberrant left ventricular perfusion which may ultimately lead to myocardial ischemia and infarction in children having the abnormality. ALCAPA may manifest as an isolated defect but in 5% of cases it may be associated with other cardiac anomalies such as atrial septal defect, ventricular septal defect, and aortic coarctation. We present a case of 7 years female with ALCAPA with collaterals between RCA and LCA and additional findings of juxtaposition of left atrial appendage. Juxtaposition of atrial appendage is associated with some major congenital heart diseases, transposition of great vessels being the common one. In our case, however, juxtaposition of left atrial appendage is associated with ALCAPA. Surgery is the definite treatment modality for ALCAPA available till date. Early diagnosis of ALCAPA with the help of multislice CT angiography is always good for the patient to prevent the possible grave consequences.