Cardiac imaging in a patient with anomalous origin of the left coronary artery from the pulmonary artery - A case report

Anomalous origin of the left coronary artery from the pulmonary artery (ALC APA) is an uncommon congenital heart disease and has a high mortality rate in infancy. However, myocardial ischemia does not develop until adolescence or adulthood in about 10% of patients. Moreover, the diagnosis of ALCAPA i s often difficult in cases without heart murmur or cardiac symptoms. The au thors report the case of a 31-year-old man with ALCAPA. He was admitted to the hospital for evaluation of mild shortness of breath at exercise, but he had no typical chest symptoms due to myocardial ischemia or heart failure until age 31 and he had no heart murmur. Moreover, electrocardiogram did no t show an old myocardial infarction or myocardial ischemia. Therefore, the authors did not suspect ALCAPA until they performed transthoracic echocardi ography and exercise-stress single photon emission computed tomography (SPE CT) with Tc-99m-tetrofosmin. The final diagnosis was established from the r esults of coronary arteriography. In the present case, a transthoracic echo cardiogram showed abnormal coronary circulation, and exercise-stress SPECT revealed reversible myocardial ischemia. Transthoracic echocardiography and myocardial SPECT imaging could be a useful noninvasive tools for diagnosin g the ALCAPA.