Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery (Alcapa) in An Old Adult

The anomalous origin of the left coronary artery from the pulmonary artery (alcapa) is a rare congenital cardiac malformation. it presents predominantly in infancy and its main presenting feature is myocardial ischemia or heart failure. survival to adulthood is quite uncommon. if untreated, mortality from alcapa approaches 90% in infancy; early recognition and surgical correction are, therefore, essential. with early surgical correction, the prognosis is good. there are two types of alcapa syndrome: the infant type and the adult type, each of which has different manifestations and outcomes. infants experience myocardial infarction and congestive heart failure, and approximately 90% die within the first year of life. a literature review regarding this anomaly in teenagers and adults show that only 25 cases have been diagnosed during life and 18 additional cases of alcapa in these age groups have been diagnosed post mortem. we present a rare case of a 60-yearold man, who referred to our center due to dyspnea on exertion from the previous year without any history of chest pain and diagnosed as alcapa. given the absence of ischemia and the patient’s age, only medical therapy was recommended.