ABC | Volume 114, Nº4, Suplement, April 2020

Case Report Bu & Zhao Image Diagnosis: ALCAPA Arq Bras Cardiol 2020; 114(4Suppl.1):4-7 Figure 1 – Transthoracic echocardiography showed moderate mitral regurgitation (A) and the RCA diameter was increased at the proximal end (B, arrows), and the LCA was not from left crown sinus (C, arrows) and inserted into the pulmonary artery (D, arrows). RV: right ventricle; RA: right atrium; LV: left ventricle; LA: left atrium; AV: aortic valve; RCA: right coronary artery; LCA: left coronary artery; PV: pulmonary valve. Figure 2 – Computed tomography angiography scan image showed a giant and twisted RCA(Aand C, arrows) andALCAPA(B and D, arrows).AV: aortic valve; RCA: right coronary artery; LCA: left coronary artery; PA: pulmonary artery. Echocardiography is the mainstay of non-invasive diagnostic tool during early screening that depicts the abnormal origin of the LCA with an abnormal jet, left ventricular dilatation, dilated RCA, retrograde filling, the mild hypokinesis of the anterior wall, presence of hyperechogenicity of the endocardium and/or papillary muscles, the RCA diameter as a ratio of the aorta ring diameter, etc. 4 The diagnosis of ALCAPA has traditionally been made by coronary angiography. In recent years, coronary computed tomographic angiography (CCTA) has emerged as the standard of reference for identification and characterization of coronary artery anomalies. CCTA allows a non-invasive accurate diagnosis, depicting the origin and course of the coronary arteries. Additionally, it offers a three-dimensional assessment of the anatomic relations between coronary arteries and adjacent structures, 6 and it provides sectional views of cardiac structures from various angles. Hence, it could be considered as the imaging modality of choice to noninvasively delineate coronary vessel anatomy. Moreover, it plays an important role in surgical intervention planning, and it may be a valuable postoperative follow-up tool for patients. 7 5