Anomalous Left Coronary Artery Arising from the Pulmonary Artery (ALCAPA): The Critically Important Role of Color Flow Doppler in Identifying a Rare Intramural Course

•ALCAPA must be considered in an infant with ischemia and/or heart failure.•A rare variant with intramural aortic course may appear normal on 2D echo.•Retrograde color flow in the LCA is highly suspicious for this lesion.•Ambiguous cases will benefit from multimodality imaging via catheterization or CT.•Early recognition may lead to lifesaving surgical correction.