Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is an uncommon congenital anomaly. We report a rare association of ALCAPA with tetralogy of Fallots (TOF). The physiology, clinical presentation and specific echocardiographic clues that suggest diagnosis in these circumstances can be different from a patient having isolated ALCAPA. In such clinical scenario, the anesthesiologist should able to recognize the echocardiographic features of the coexistence of ALCAPA and be aware of the potential pitfalls.
Dodge-Khatami A, Mavroudis C, Backer CL: Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy. Ann Thorac Surg 74:946-955, 2002
Wilcox WD, Hagler DJ, Danielson GK, Smith HC, Fulton RE (1979) Anomalous origin of the left coronary artery from the pulmonary artery in association with intracardiac lesions. J Thorac Cardiovasc Surg 78:12–20
Yang Yl, Nanda NC, Wang XF, et al: Echocardiographic diagnosis of anomalous origin of left coronary artery from the pulmonary artery. Echocardiography 24:405-411, 2007
Karunadasa R, Buxton BF, Dick R, et al: Anomalous origin of left coronary artery from the pulmonary artery does the management in the adult differ from that of the infant? Four cases of the Bland-White-Garland Syndrome. Heart Lung Circ 16:S29-S33, 2007
Carvalho JS, Silva CM, Rigby ML, Shinebourne EA. Angiographic diagnosis of anomalous coronary artery in tetralogy of Fallot. British Heart Journal. 1993;70(1):75-78.
Bitar FF, Kveselis DA, Smith FC, Byrum CJ, Quaegebeur JM. Double-outlet right ventricle (tetralogy of Fallot type) associated with anomalous origin of the left coronary artery from the right pulmonary artery: report of successful total repair in a 2-month old infant. Pediatr Cardiol 1998; 19: 361–362.
Kurup RP, Daniel R, Kumar RK. Anomalous origin of the left coronary artery from the pulmonary artery in infancy with preserved left ventricular function: potential pitfalls and clues to diagnosis. Ann Pediatr Cardiol 2008; 1: 65–67.
Kececioglu D, Kotthoff S, Konertz W, Scheid HH, Vagt J. Pulmonary artery origin of the left coronary artery: Diagnosis by transesophageal echocardiography in infancy. Eur Heart J 1993;14:1006-7.