Late Adult Presentation Of Anomalous Left Coronary Artery From The Pulmonary Artery Syndrome: The Utility Of Cardiac Computed Tomography In The Diagnostic Evaluation Of Cardiac Patients

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome is a very rare congenital Coronary artery anomaly with uncommon presentation in adulthood but a cause of sudden cardiac death. A 62-year-old female with no cardiac history presented with complaints of non-exertional chest discomfort. Her EKG was unremarkable but her cardiac troponin was mildly elevated. Functional assessment using a Regadenoson myocardial perfusion imaging showed no normal LV function without reversible ischemia. Based on her recurrent symptoms and intermediate probability of coronary artery disease, a Cardiac CT was done and demonstrated an anomalous LCA origin from the pulmonary trunk (Fig 1). She was referred for surgical repair. The possibility of adult cardiac congenital anomaly should be considered in the diagnostic evaluation of chest pain especially following unremarkable results from functional assessment tests. ECG gated Cardiac CT angiography is the preferred non-invasive diagnostic modality to visualize direct anomalous LCA origin from the main PA. Surgical repair is the definitive treatment.In the evaluation of adults with cardiac symptomatology, congenital cardiac anomalies should be considered in the differentials in the appropriate clinical settings, especially when functional evaluations are negative.