Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly first described in 1908 and has an incidence of 0.26% of all cases of congenital heart diseases. Nearly 90% of patients die within one year if left untreated; however, a few patients can survive into adulthood. This depends on the inflow of blood to the left coronary artery (LCA) via collaterals from the right coronary artery (RCA). We report a case of a 45-year-old woman referred to the preoperative anesthesia clinic in April 2017 for a laparoscopic hysterectomy under general anesthesia.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly first described in 1908 and has an incidence of 0.26% of all cases of congenital heart diseases. The left coronary artery arises from the pulmonary artery, instead of branching from the aorta. ALCAPA is usually an isolated cardiac anomaly but, in rare incidences, it has been described with other congenital heart defects. These other congenital heart defects are: Patent Ductus Arteriosus, Ventricular Septal Defect, Tetralogy of Fallot, and Coarctation of the Aorta. The usual clinical course is severe left-sided heart failure, myocardial necrosis, and severe arrhythmias during the first few months of life, when the pulmonary vascular resistance drops.

Nearly 90% of patients die within one year if left untreated; however, a few patients can survive into adulthood; this depends on the inflow of blood to the left coronary artery (LCA) via collaterals from the right coronary artery (RCA).The adult form of ALCAPA may occur in approximately 10-15% of cases. A high proportion of them present with impaired LV contractile function associated with severe dilated cardiomyopathy and significant mitral regurgitation. Other presentations are exertional angina, acute myocardial infarction, malignant arrhythmias or sudden cardiac death.

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Anesthesiology Case Reports