title: ALCAPA in an Octogenarian Woman: An Enigma.
abstract: ALCAPA syndrome (anomalous origin of the left coronary artery from the pulmonary artery) is an exceedingly rare disease but lethal with clinical expression from myocardial infarction, congestive heart failure to death during early infancy and rare survival to adulthood. A 75-year-old woman with ALCAPA syndrome presented with angina (Canadian Cardiovascular Society functional class II) over past 8 months. Physical examination was within normal limits except pan-systolic murmur at the apex. Electrocardiography displayed poor R progression in precordial leads and signs of left ventricular hypertrophy. Echocardiography established presence of continuous flow entering the pulmonary trunk and normal systolic function. Coronary angiogram showed absence of left coronary artery originating from aorta, dilated and tortuous right coronary artery (RCA) and abundant Rentrop grade 3 intercoronary collateral communicating with left coronary artery originating from pulmonary trunk which was also confirmed on CT angiogram thus establishing diagnosis of ALCAPA. Survival in eight decade with this anomaly is still an enigma.
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, G. T. Road, Kanpur, Uttar Pradesh, 208002, India.
authors.forename: Santosh Kumar
authors.initials: SK
authors.lastname: Sinha
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, G. T. Road, Kanpur, Uttar Pradesh, 208002, India.
authors.forename: Chandra Mohan
authors.initials: CM
authors.lastname: Verma
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, G. T. Road, Kanpur, Uttar Pradesh, 208002, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Krishna
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, G. T. Road, Kanpur, Uttar Pradesh, 208002, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Thakur
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, G. T. Road, Kanpur, Uttar Pradesh, 208002, India.
authors.forename: Barun
authors.initials: B
authors.lastname: Kumar
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, G. T. Road, Kanpur, Uttar Pradesh, 208002, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Goel
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, G. T. Road, Kanpur, Uttar Pradesh, 208002, India.
authors.forename: Surendra
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, G. T. Road, Kanpur, Uttar Pradesh, 208002, India.
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, G. T. Road, Kanpur, Uttar Pradesh, 208002, India.
authors.forename: Mukesh Jitendra
authors.initials: MJ
authors.lastname: Jha
keywords: ALCAPA syndrome; Arrythmia; Collateral circulation; Ischemic cardiomyopathy