Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA) in an Infant - A Case Report

Abstract

IntroductionAnomalous origin of the left coronary artery (LCA) from the pulmonary artery (abnormal left coronary artery from pulmonary artery = ALCAPA) or BladeWhite-Garland syndrome is a rare, but serious congenital cardiac malformation. ALCAPA represents one of the most common causes of myocardial ischaemia and infarction in children. If left untreated, the mortality rate is upto 90% within the first year of life. ALCAPA accounts for 0.25-0.50% of all congenital heart diseases. 1 Although the anomalous origin of the coronary arteries that arise from the pulmonary artery was first described in1886. 2 It was not until 1933 when Bland et al 3 described the first clinical features with an autopsy finding of anomalous left coronary artery arise from the pulmonary artery (ALCAPA). The anomaly has thus been called the Bland-White-Garland Syndrome. 3,4 A coronary artery anomaly may involve an abnormal number, origin and/ or course, termination or structure of the coronary arteries. 5 The left main coronary artery normally arises from the left coronary sinus of valsalva. Instead of arising from the left aortic sinus, it may arises from the right sinus of valsalva or the proximal right coronary artery, from the non-coronary (posterior) aortic sinus,