Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a
rare congenital anomaly that usually manifests in childhood and has a
high mortality rate in the first year of life if not corrected. We
present the case of a middle-aged woman who presented with exertional
dyspnea and severe ischemic mitral regurgitation; further imaging
revealed it was secondary to ALCAPA. The patient was referred for
valvular reconstruction and surgical revascularization with left
coronary artery reimplantation in the aorta. The patient had an adequate
postoperative result and symptomatic improvement during follow-up.
Although ALCAPA is a rare cause of mitral regurgitation in adults, its
pathophysiology is like that of ischemic origin from atherosclerotic
coronary disease, and its treatment is therefore similar to obtain
adequate clinical improvement.