Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA): A Case Report

Anomalous origin of the left coronary artery from the pulmonary artery, commonly designated as ALCAPA or Bland-White-Garland syndrome, constitutes a rare yet clinically critical congenital coronary anomaly.The condition is characterized by the emergence of the left coronary artery from the pulmonary arterial trunk rather than from the aortic sinus, resulting in compromised myocardial perfusion.The ensuing coronary steal phenomenon and progressive left-to-right shunting predispose affected patients to myocardial ischemia, ventricular dysfunction and, in the absence of treatment, a high risk of early mortality.Although the anomaly may occur in isolation, it is occasionally associated with additional congenital cardiac malformations.We report the case of a one-year-old infant in whom ALCAPA was identified through multimodality imaging, including echocardiography and multislice computed tomography coronary angiography.Imaging demonstrated marked dilatation of the right coronary artery, extensive intercoronary collateralization and an associated juxtaposition of the left atrial appendage.This report highlights the diagnostic value of advanced cardiac imaging in defining coronary anatomy and guiding definitive surgical management while underscoring the importance of early detection in improving clinical outcomes.