Silent Messenger of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA)

Abstract

Abnormal origin of the left coronary artery from the pulmonary artery syndrome (ALCAPA) is a rare congen ital heart disease. While in is usually seen is an isolated anomaly, other heart anomalies may also be seen in 5% of cases. There are several case reports in the literature showing that mitral regurgitation in children may be a silent precursor of ALCAPA, especially in late presenting cases. Therefore, coronary arteries should be carefully evaluated, particularly in children with mitral regurgitation. A 4year old asymptomatic male who was followed up with the diagnosis of mild mitral regurgitation and mitral cleft was last checked 2 years ago. In the current evaluation, despite no problems being detected in the patient’s physical development and exercise capacity, a mesocardia systolic 2/6 murmur was detected. In the ECG, the T wave changes in DI and aVL were remarkable. In the echocardiographic examination, evident views were obtained.Following the echocardiographic evaluation, the patient underwent catheterization and the was referred for correction surgery. Mitral regurgitation may be an early and innocent looking messenger of the abnormal origin of the left coronary artery from the pulmonary artery syndrome. There are a few case reports in the literature indicating that mitral regurgitation in children is a silent precursor of ALCAPA. Our aim is to contribute to the literature to make this important condition more known. Therefore coronary arteries should be carefully evaluated, particularly in children with mitral regurgitation.