Fig. 2

Case of anomalous left coronary artery from the pulmonary artery (ALCAPA). A Schematic of anatomical abnormality; B LCA from main pulmonary artery (MPA); C dilated RCA from subcostal window; D anomalous coronary artery flow was visualized along the course of the ventricular septum. TTE findings of ALCAPA include an abnormal left coronary artery arising from the pulmonary artery with retrograde coronary flow (CFM adjusted to low scale frequency). Prominence of the RCA and coronary artery collaterals may also be present. ALCAPA may be misdiagnosed for primary endocardial fibroelastosis due to the increased echogenicity and fibrotic appearance of the papillary muscle associated with this anomaly. It can be best visualised using the high left parasternal short axis window with subtle anterior angulation. Care should be taken as to determine the true origin of the LCA arising from the aorta. Difficulty in defining the LCA, with the presence of a dilated RCA, should further arouse suspicion for ALCAPA