Silent Intruder: Unveiling Asymptomatic Anomalous Left Coronary Artery in Adulthood

Anomalous left coronary artery from the pulmonary artery (ALCAPA), a rare congenital heart anomaly, typically manifests with heart failure symptoms in infants and carries a high mortality rate without surgical intervention. Patients are categorized into adult and infantile types based on collateral presence, impacting cardiovascular risk. Interestingly, some patients may remain asymptomatic for decades due to adequate collateral development, with a decreasing risk of sudden death as they reach adulthood. Management of asymptomatic cases requires individualized consideration and diagnostic confirmation before intervention, despite decreasing risk of sudden death with age. We report a case involving a 35-year-old asymptomatic woman who came for a routine annual check-up. While her electrocardiography, ECHO was normal, a positive Treadmill stress test prompted coronary angiography, revealing an incidental diagnosis of ALCAPA. Subsequently, the patient was referred to cardiothoracic and vascular surgery for further evaluation and necessary interventions, but the patient denied surgery as she did not accept the risk in view of asymptomatic status.