Anomalous origin of the coronary artery from the pulmonary artery in a 33-year-old man

Description 

A 33-year-old man, without prior history of coronary artery disease, was referred to a catheterisation laboratory with a diagnosis of non-ST elevation myocardial infarction. Coronary angiogram showed a dilated, dominant right coronary artery of normal origin with multiple collaterals draining to the left coronary system (figure 1A,B) and a coronary 'steal' phenomenon into the pulmonary artery (PA). Left main coronary artery (LMA) was not visualised on contrast injection into the aortic root (figure 1B). Ventriculogram showed ejection fraction of 40%–45% and anterior wall hypokinesis. Subsequent three-dimensional heart computer tomogram revealed anomalous origin of the LMA from PA, (figure 1C), confirming the diagnosis of anomalous origin of the coronary artery from the pulmonary artery (ALCAPA).

Figure 1

(A) Left anterior oblique (LAO) view. Large dominating RCA with extensive collaterals to the left coronary system. (B) Failure to visualise left coronary artery...

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