Introduction: Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac malformation in which the left coronary artery arises from the pulmonary artery. It usually presents during the first months of life with features of myocardial ischemia or heart failure. It is potentially fatal with a high mortality rate in the first year of life; however, the prognosis is good with early surgical correction.

Case Presentation: We report a five-year-old female presented with exertional chest pain, dyspnea, and palpitation. Echocardiography and coronary angiography revealed an anomalous left coronary artery arising from the pulmonary artery with mitral regurgitation. She underwent successful surgery to establish a dual-coronary system, where the left internal thoracic (mammary) artery was used to revascularise the left coronary artery with mitral valve repair. Excellent surgical results were obtained, and the patient was discharged from the hospital without complaints, and the five-year follow-up proved the efficacy of such technique.

Conclusion: Using the internal thoracic artery as a graft is an alternative for the treatment of anomalous origin of the left coronary artery from the pulmonary artery in children when re-implantation is not feasible. 


Keywords: Coronary vessel, Anomalies, Left coronary artery, Mitral regurgitation, Internal thoracic artery
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