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

## TL;DR

A rare heart condition in an infant, where the left coronary artery originates from the right pulmonary artery, was successfully treated with surgery.

## Contribution

This case report presents a rare congenital heart anomaly and its successful surgical correction.

## Key findings

- The infant showed symptoms like respiratory distress and poor feeding due to ALCARPA.
- Imaging confirmed the anomalous origin of the left coronary artery from the right pulmonary artery.
- Surgical anastomosis using treated pericardium led to uneventful postoperative recovery.

## Abstract

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.