Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly with an incidence of 1 in 300,000 live births and represents 0.25 to 0.5 per cent of all cases of congenital heart disease. Most of the cases (85%) are diagnosed within first month of life. Nearly 90 per cent of untreated patients die within one year with myocardial ischemia and infarction or congestive cardiac failure with mitral regurgitation. However, a few patients can survive into adulthood due to adequate collateral blood supply to the left coronary circulation through dominant right coronary artery. Regional wall motion abnormality is commonly seen in most of the patients with ALCAPA surviving till adult life. Adult ALCAPA can present as effort angina due to relative ischemia and coronary steal. Acute presentation though common in infancy, is relatively rare in patients who survive to adulthood due to adequate collaterals. Here we present a 44 year male patient presenting as acute coronary syndrome and being finally diagnosed as adult ALCAPA in the cath lab. The patient was successfully treated with surgery.
Key words: Acute coronary syndrome, Anomalous origin of the left coronary artery from the pulmonary artery, Coronary anomalies, Myocardial infarction, Echocardiography.