Unique Echocardiographic Markers of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) in the Adult

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect in adults. We report a 38-year-old male presenting with exertional syncope. He was referred for the evaluation of multiple muscular ventricular septal defects diagnosed on an outpatient echocardiogram. Echocardiography revealed mild left ventricular enlargement, abnormal flow-pattern in the ventricular septum and dilatation of the right coronary artery. Pulsed-wave Doppler with sample volume placed in the coronary ostium showed systolic coronary flow predominancy. This unique finding is characteristic for ALCAPA and can differentiate it from other coronary anomalies. Coronary angiography confirmed ALCAPA syndrome. Surgical correction was planned. Mini-Abstract Late presentation of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is rare. Herein, we report a 38-year-old male with ALCAPA presenting with exertional syncope. Echocardiography revealed mild left ventricular enlargement, abnormal flow-pattern in the ventricular septum and dilatation of the right coronary artery. Pulsed-wave Doppler echocardiography with sample volume in the coronary ostium showed systolic coronary flow predominancy. This unique echocardiographic finding is characteristic for ALCAPA and can differentiate it from other coronary anomalies. Coronary angiography confirmed the ALCAPA syndrome. Surgical correction was planned.