Coronary Artery Bypass Grafting in an Elderly Patient with Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

We report a case of a 73-year-old woman who was diagnosed with anomalous origin of the left coronary artery(LCA) from the pulmonary artery(ALCAPA) by coronary angiography. Drug stress myocardial perfusion scintigraphy demonstrated myocardial ischemia in the left anterior descending coronary artery (LAD) region. She underwent single coronary artery bypass grafting to LAD using left internal thoracic artery (LITA) and direct closure of the origin of the anomalous LCA. Postoperative coronary catheterization revealed a patent graft showing no residual shunt from the pulmonary artery into the left coronary artery. Myocardial scintigraphy proved improvement of the ischemia. In general, once ALCAPA is diagnosed, early surgical intervention is recommended. However, since there are few reports regarding surgical treatment for ALCAPA in elderly patients, the optimal treatment strategy is not completely established. Therefore careful long-term follow-up is mandatory.