Separham and Aliakbarzadeh Journal of Medical Case Reports 2012, 6:12 http://www.jmedicalcasereports.com/content/6/1/12 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Anomalous left coronary artery from the pulmonary artery presenting with aborted sudden death in an octogenarian: a case report Ahmad Separham* and Parvaneh Aliakbarzadeh Abstract Introduction: We report a rare coronary anomaly presenting with aborted sudden death in an octogenarian. An anomalous left coronary artery from the pulmonary artery is a rare coronary anomaly which usually presents in the first year of life. Survival into adulthood and the elderly years is extremely rare. Case presentation: An 85-year-old Caucasian woman was brought to our hospital following cardiopulmonary arrest. After prolonged resuscitation and stabilization of our patient, further evaluation revealed an anomalous left coronary artery from pulmonary artery syndrome. She was discharged on medication. Conclusion: An anomalous left coronary artery from the pulmonary artery can present in elderly and even octogenarian patients. Careful history, physical examination and an appropriate invasive study are needed to confirm the diagnosis. Introduction Anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA), also known as Bland- White-Garland syndrome is a rare congenital anomaly occurring in one in 300,000 births [1].The typical clini- cal course is severe left-sided heart failure presenting at the age of one to two months [2]. Without surgical intervention, most patients with ALCAPA die within the first year of life [3]. In adult life, symptoms may range from dyspnea, chest pain and exercise intolerance to sudden cardiac death. We describe a case of an ALCAPA in an 85-year-old woman who presented with aborted sudden death. Case presentation An 85-year-old Caucasian woman experienced sudden loss of consciousness during walking. She was brought to our hospital and found to be in ventricular fibrilla- tion. After prolonged resuscitation, our patient con- verted to sinus rhythm with stable hemodynamics. She had no coronary risk factors or history of cardiovascular disease. A cerebral computed tomography scan was * Correspondence: a_separham2005@yahoo.com Department of Cardiology, Cardiovascular Research Center, Shahid Madani Heart Hospital, Tabriz, Iran found to be normal. Her serial cardiac enzymes were negative and an electrocardiogram had non-specific ST- T changes. Echocardiography showed reduced left ven- tricle systolic performance with an ejection fraction of 40%, global hypokinesia and mild mitral regurgitation. There was no evidence of her previous echo findings or left ventricular ejection fraction. After three days and extubation of our patient, a coronary angiography and cardiac catheterization was performed. Her left main coronary artery could not be selectively engaged. A selective right coronary injection using a right Judkins catheter showed a large and tortuous right coronary artery arising from the right sinus of Valsalva. The left coronary artery was filled through collaterals from the right coronary artery (RCA). The anomalous origin of the left coronary artery was demonstrated in the late phase of RCA injection (Figures 1 and 2, Additional file 1). The calculated left to right shunt (pulmonic blood flow to systemic blood flow ratio) was 1.01. A diagnosis of ALCAPA syndrome was confirmed. She was dis- charged home with stable cardiovascular and neurologic status a few days later. © 2012 Separham and Aliakbarzadeh; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.