Anomalous Origin of the Left Coronary Artery From the Right Pulmonary Artery (ALCARPA): A Case Report

Although the congenitally anomalous left coronary artery (LCA) is a rare condition, it can give rise to a most rare case, which is an anomalous LCA from the right pulmonary artery (RPA) (ALCARPA). If left untreated, ALCARPA results in myocardial territories receiving low-pressure, oxygen-poor blood. A male infant aged eight months exhibited signs of respiratory distress, poor feeding, and precordial activity. The diagnosis of ALCARPA is usually considered in infants with otherwise unexplained left ventricular dysfunction or mitral valve regurgitation. Imaging studies, including computed tomography angiography and echocardiography, showed a markedly dilated right coronary artery and a dilated left ventricle, confirming ALCARPA. Using autologous pericardium treated with glutaraldehyde, the abnormal LCA was directly anastomosed to the aorta. Postoperative recovery was uneventful, with elective inotropic support provided. To prevent fatal arrhythmias and myocardial ischemia, prompt diagnosis and surgical creation of a dual-coronary system are essential.