Aortopulmonary Window With Wayward Coronaries: A Rare Cardiac Confluence

An aortopulmonary window (APW) is a congenital cardiac anomaly typically associated with other cardiovascular defects, though it may rarely be linked to anomalous origins of the coronary arteries.We present the case of a 30-year-old male diagnosed with APW with abnormal coronary artery origins.A CT coronary angiogram revealed that the left main coronary artery originated from the APW, while the right coronary artery exhibited a high take-off from the left side of the ascending aorta, with a malignant inter-arterial course.The patient was advised to undergo surgical repair involving coronary reimplantation; however, he declined the procedure and opted for conservative management with regular follow-up.