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CC BY-NC-ND 4.0 · Indian J Radiol Imaging
DOI: 10.1055/s-0045-1802670
Case Reports

Left Ventricular Myocardial Perfusion before Contrast Pool in Ventricular Cavity in Cardiac MRI in Adult Type Anomalous Left Coronary Artery from Pulmonary Artery with Pulmonary Hypertension

Basavaraj Birardar 
1   Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
,
Jineesh Valakkada 
1   Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
,
Anoop Ayappan 
1   Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
,
Deepmala Karamakar
1   Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
,
Bijulal Sasidharan
2   Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Abstract

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary anomaly. It has two types, infant and adult types, each with different clinical manifestations and prognosis. Here we report an adult type of ALCAPA syndrome presenting with recurrent syncope and diagnosed as dilated cardiomyopathy with pulmonary hypertension on echocardiography. Cardiac magnetic resonance imaging (MRI) was able to establish ischemia as the cause of dilated cardiomyopathy and raised the suspicion of ALCAPA. Computed tomography (CT) coronary angiogram subsequently confirmed the anomalous origin of the left coronary artery from the main pulmonary artery with right to left shunting due to pulmonary artery hypertension. Viability assessment on cardiac MRI provides additional information for treatment planning. This case highlights the importance and subtle markers in cardiac MRI for ALCAPA presenting with atypical clinical presentation.

Keywords

ALCAPA - cardiac MRI - PAH - perfusion abnormality

Authors' Contributions

B.B. contributed to data collection, manuscript preparation, and revision of the manuscript. J.V. contributed to the concept of the study, manuscript preparation, and final approval. A.A. contributed to manuscript preparation, revision of the manuscript, and final approval. D.K. contributed to manuscript preparation. B.S. contributed to revision of manuscript.




Publication History

Article published online:
27 March 2025

© 2025. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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