Non-ST-Segment Elevation Myocardial Infarction in a Woman in her Fifth Decade Secondary to Anomalous Left Coronary Artery from The Pulmonary Artery (ALCAPA) Treated with Surgical Correction Using The Takeuchi Technique: A Case Report

Abstract

Anomalous left coronary artery from the pulmonary artery (ALCAPA), also known as Bland-White-Garland syndrome, is a rare congenital coronary anomaly with an estimated incidence of 1 in 300,000 live births and represents less than 0.5% of all congenital heart diseases. The condition is characterized by the abnormal origin of the left coronary artery from the pulmonary artery, resulting in progressive myocardial ischemia after the physiological decline in pulmonary vascular resistance during infancy. The subsequent coronary steal phenomenon leads to left ventricular dysfunction, myocardial infarction, mitral regurgitation, heart failure, malignant ventricular arrhythmias, and sudden cardiac death if left untreated. Clinical manifestations vary according to the degree of collateral circulation and the patient's age, ranging from severe heart failure in infancy to exertional angina, syncope, ventricular arrhythmias, or sudden death in adults. Transthoracic echocardiography remains the first-line diagnostic modality, while coronary computed tomography angiography, cardiac magnetic resonance imaging, and invasive coronary angiography provide detailed anatomical and functional assessment for diagnosis and surgical planning. Surgical correction aimed at restoring a dual-coronary circulation is the treatment of choice in all patients regardless of age or symptoms, with direct reimplantation of the anomalous coronary artery into the aorta considered the preferred technique. Advances in imaging and surgical management have markedly improved long-term survival and ventricular recovery. Nevertheless, lifelong follow-up is recommended to monitor residual myocardial dysfunction, mitral valve disease, ventricular arrhythmias, and other late complications. Early recognition and timely surgical intervention remain the cornerstone for achieving favorable clinical outcomes.