Conclusion
ARCAPA diagnosis is often challenging especially in neonates, usually asymptomatic, and in critically ill patients with ventilatory mechanic assistance or poor acoustic windows. Given its peculiar pathophysiology, hemodynamic conditions (such as ECMO, high pulmonary pressure, etc …) can make its recognition very difficult. Echocardiography is a precious tool in expert hands and subtle pitfalls, depending on hemodynamic conditions, should always be taken into consideration. Although less aggressive than ALCAPA, ARCAPA leads to myocardial ischemia and also in asymptomatic neonates or children elective surgical repair is recommended.