Sinus- And Commissure-Based Innovative Classification (Rpksai) of Alcapa: Surgical Implications

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac anomaly with potentially fatal outcomes if untreated. Traditional classications have emphasized infantile versus adult types or collateralization patterns. We propose a novel classication (RPKSAI CLASSIFICATION FOR ALCAPA) based on the precise origin within the pulmonary sinuses or commissures, which directly informs surgical repair. This scheme includes anterior, posterior, and commissural origins, as well as remote non-facing sinus variants, highlighting surgical feasibility for direct reimplantation, intrapulmonary tunneling, or ap-based reconstructions. The classication aims to guide surgical decision-making, reduce technical challenges, and improve outcomes.