https://orcid.org/0000-0002-0865-0310
A 16-month-old boy was referred for further diagnostic evaluation. He was diagnosed at 14 months of age with tetralogy of Fallot after he presented at a local clinic with history of cyanosis and shortness of breath with feeding and activity. Echocardiography demonstrated right outflow obstruction with a peak gradient of 65 mmHg, and a large ventricular septal defect (VSD) with overriding aorta. The left ventricular function was normal with ejection fraction of 60%. On the echocardiogram, the left coronary artery (LCA) was suspected to arise from the pulmonary artery (ALCAPA), which prompted referral to our centre for evaluation of the coronary arteries. A contrast-enhanced CT angiogram confirmed the overriding aorta, VSD (Panel A), pulmonary stenosis, and the presence of ALCAPA with the LCA arising from the proximal pulmonary artery (Panels B–D). Multiple small aortopulmonary collaterals were seen. The coexistence of ALCAPA and TOF is extremely rare. In this case, interestingly ventricular function was preserved. The patient underwent an uncomplicated complete surgical repair. At 7-year follow-up, he continues to do well.
Author contribution
W.T.S. and R.T. were equally involved in preparation of this manuscript.
Consent: Patient consent was obtained for the purpose of this report.
Funding: None declared.
Author notes
Conflicts of interest: None declared.
