Long-term survival after late surgical repair of adult anomalous origin of the left coronary artery from the pulmonary artery

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary anomaly, occurring in approximately 1 in 300 000 live births and accounting for 0.25%-0.5% of all congenital heart diseases [1,2].If left untreated, ALCAPA carries a mortality rate approaching 90% during infancy, primarily due to myocardial ischemia and heart failure (HF).In patients who survive into adulthood, extensive collateral circulation from a dilated right coronary artery (RCA) to the left coronary system may sustain myocardial perfusion; however, this adaptation predisposes to left ventricular dilation, ischemic mitral regurgitation, and chronic HF [3].Adults may remain asymptomatic or present with angina, dyspnea, or HF, but the risk of sudden cardiac death remains markedly elevated, with most