ABC | Volume 114, Nº4, Suplement, April 2020

Case Report Bu & Zhao Image Diagnosis: ALCAPA Arq Bras Cardiol 2020; 114(4Suppl.1):4-7 Figure 3 – Ascending aorta angiography showed dilated and twisted RCA and ALCAPA (A and B, arrows) as well as a phenomenon of stealing blood (C and D, arrows). RCA: right coronary artery; LCA: left coronary artery. Figure 4 – Computed tomography angiography scan image showed a giant RCA (A, B and C, arrows) and ALCARPA (C, arrows); Ascending aorta angiography only showed dilated and twisted RCA (D, arrows) and a phenomenon of stealing blood (E and F, arrows). Ao: aorta; RCA: right coronary artery; LCA: left coronary artery; LPA: left pulmonary artery; RPA: right pulmonary artery. The increasing use of cardiac magnetic resonance imaging (MRI) has not only increased the diagnostic yield but also enabled a better assessment of the consequences of myocardial hypoperfusion and associated congenital defects. The presence of left ventricular dilatation, subendocardial scarring , and regional wall motion abnormalities are indicators of chronic ischemia. And the presence of delayed subendocardial enhancement may be seen on cardiac MRI images, which suggests chronic subendocardial ischemia and is considered as a very important sign, particularly in asymptomatic patients. 3 Surgical correction should be strongly considered if this finding is present. Cardiac MRI has been increasingly utilized in multiple other studies to guide both diagnostic and therapeutic decisions in patients with ALCAPA. Reimplantation into the aorta is the only true anatomical repair, but the benefits of MVS at the time of ALCAPA operation should be weighed against the effects of prolonged bypass in the setting of an already ischemic left ventricle. 3 After mitral 6