missed diagnosis and treatment dilemma: large patent ductus arteriosus combined with anomalous origin of the left coronary artery from the pulmonary artery

An anomaly of the left coronary artery, originating from the pulmonary trunk, is called anomalous origin of the left coronary artery from the pulmonary artery (alcapa) syndrome. this syndrome is an infrequent congenital anomaly, mostly seen in children. usually, because of the anomaly, myocardial perfusion failure occurs. this anomaly presents even less frequently in adults. the symptoms of alcapa develop in the early ages. congestive heart failure is an important result of alcapa, as well as mitral insufficiency and left ventricular (lv) dysfunction. if there is a patent ductus arteriosus (pda) or ventricular septal defect (vsd), high pulmonary artery pressures decreases and the coronary anomaly and perfusion defect can be hidden. here we present a case of a large pda combined with alcapa, as seen in one of the oldest patients ever reported. recognizing pda in patients with alcapa is very important, since closure of the pda may cause catastrophic conditions. alcapa combined with pda is very rare and has been reported mostly in infants. to the best of our knowledge, there is no such case diagnosed in adulthood.