Anomalous origin of the left coronary artery from the pulmonary artery detected by echocardiography in an asymptomatic adult.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation. It is unusual for an ALCAPA patient to survive to adulthood. We present a case of an asymptomatic 54-year-old woman with this syndrome in which visualization of a markedly enlarged and tortuous right coronary artery and intercoronary collaterals by echocardiography raises suspicion for this disease and subsequently guides a step-by-step diagnosis. The patient lives well without surgery 3 years after diagnosis.