A 49-year-old woman with a history of active smoking, obesity and dyslipidemia under treatment.
She presented with a two-month history of retroactive or depressive pain radiating to the jaw and epigastrium, starting with low intensity exercise.
It was associated with neurovegetative symptoms that subsided with rest.
Physical examination was normal.
General examination (physical examination, biochemical profile, lipid profile, TSH), all normal, was requested.
Electrocardiogram was also normal and anteroposterior chest X-ray showed a slightly enlarged cardiac silhouette due to left ventricular ejection fraction.
After these results, the study was continued with a transthoracic echocardiogram, which showed a slightly hypertrophic left ventricle with preserved global function, ejection fraction of 5%.
Exercise test was performed, which was stopped at 5 minutes for pain and significant ST-segment depression with submaximal frequency.
Given the findings, a coronary angiographic study was requested, which showed: absence of the left main coronary artery (TCI) in the left coronary sinus and a large right coronary artery (CAD) hyperdominant, with no coronary artery filling
This is consistent with the diagnosis of ALCAPA syndrome.
1.
With the confirmed diagnosis of ALCAPA, the patient underwent myocardial revascularization surgery with implantation of a bypass from the left internal mammary artery to the proximal portion of the anterior descending artery and occlusion of the left main descending artery of the LCA.
After 5 days of optimal recovery, the patient was discharged.
Twenty-one days after surgery the patient reported improvement in her functional capacity and absence of angor or dyspnea.
Two years after surgery the asymptomatic patient was admitted.
5 years old, without new hospitalizations.
