ALCAPA is a rare congenital anomaly that can present in adulthood and be misdiagnosed as postpartum cardiomyopathy, highlighting the importance of multimodality imaging for accurate diagnosis and surgical correction.
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Supports ALCAPA consideration in cardiomyopathy mimics; extends sparse adult surgical data but remains hypothesis-generating.
A 30-year-old woman with a history of presumed postpartum cardiomyopathy presented to her primary care physician's office with crescendo angina and shortness of breath. She was found to be in supraventricular tachycardia, managed with the Valsalva maneuver, and was discharged home without any further workup. She again presented with exertional symptoms. Her electrocardiogram revealed abnormal T waves and her stress test was strongly positive. Cardiac catheterization revealed an absent left coronary ostium and a dilated right coronary artery, with large collaterals supplying the left coronary system; coronary computerized tomography revealed the anomalous origin of the left main coronary artery arising from the posterolateral aspect of the pulmonary artery, highly suggestive of the anomalous origin of the left coronary artery from pulmonary artery (ALCAPA) anomaly (Bland-White-Garland anomaly).
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Nepal et al. (2019) studied this question.
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