A rare congenital cardiovascular abnormality presenting as respiratory distress in an infant

Anomalous origin of left coronary artery from pulmonary artery (alcapa) is a rare congenital cardiovascular anomaly which presents in early infancy with congestive cardiac failure, sometimes precipitated by inter current respiratory tract infections. we report a case of an eight week old baby boy, with a short history of cough, difficulty in breathing, marked tachycardia and signs of respiratory distress. he was managed for bronchiolitis but eight hours later had major desaturation during feeding which needed intubation and mechanical ventilation. he improved over the next few hours and self extubated but after 12 hours needed reintubation and ventilation following a similar event of desaturation as observed previously. the chest x ray revealed cardiomegaly and diuretics were added in the on going management and he was gradually weaned off from the ventilator. the echocardiography examination revealed alcapa, resulting in myocardial ischaemia. surgical revascularization was performed and baby was discharged after ten days on regular anti failure medication in a stable condition.