Sir,—Case 2 from this report1 has subsequently been admitted with chest pain and polymorphic ventricular tachycardia (VT). This was initially treated with oral β blockers, but at electrophysiological testing the VT was still inducible. Coronary angiography showed no significant change from her previous angiogram. A myocardial perfusion scan with adenosine stress confirmed an anterior myocardial infarction with some flow reduction in the peri-infarct zone. There is difficulty in demonstrating reversible ischaemia in the presence of ALCAPA; however, she has been referred for surgical revascularisation and will be given an implantable cardioverter defibrillator if the VT remains inducible postoperatively.

A conservative strategy might be employed in this condition, however surgical intervention may still need to be considered for late complications.