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A 54 year old man with no modifiable coronary risk factors presented with a 10 year history of insidious onset of progressive exertional dyspnoea. He denied history of paroxysmal nocturnal dyspnoea, orthopnoea, palpitations, syncope, oedema, or claudication. Clinical examination revealed a mesomorphic normotensive male with atrial fibrillation (AF), cardiomegaly, moderate mitral regurgitation (MR), mild tricuspid regurgitation (TR), and pulmonary arterial hypertension (PAH). A chest x ray (posterioanterior) view revealed cardiomegaly, while his ECG revealed left bundle branch block and AF. Echo Doppler evaluation revealed a dilated, globally hypokinetic left ventricle with an ejection fraction of 45%, moderate MR, PAH, and mild TR.
Multislice cardiac computed tomography (16 slices) revealed anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) receiving collaterals from a normally originating dilated tortuous right coronary artery (panels). There were specks of coronary calcification, but no stenotic lesions. Coronary angiography confirmed the diagnosis and the patient underwent successful coronary artery bypass graft (CABG) surgery after closure of the ostium (in the main pulmonary artery) of the anomalously originating left coronary artery. Multislice cardiac computed tomography is thus a useful modality for diagnosing congenital coronary anomalies.
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