Separham and Aliakbarzadeh Journal of Medical Case Reports 2012, 6:12 http://www.jmedicalcasereports.com/content/6/1/12 Page 2 of 3 Figure 1 Selective right coronary angiography shows a widely dilated right coronary artery. Discussion ALCAPA is a rare congenital anomaly, first described by Brooks in 1886. It is usually seen as an isolated lesion. This anomaly, also known as Bland-White-Garland syn- drome, accounts for about 0.25% to 0.5% of congenital heart defects [4]. Symptoms usually occur in the first Figure 2 Retrograde filling of the left anterior descending artery, left circumflex artery and main pulmonary artery on delayed imaging after contrast injection of the right coronary artery. few months of life. Late presentation in the adult or elderly stage of life is extremely rare. Insufficient collat- eral flow from the right coronary artery with a coronary steal from the left coronary artery into the pulmonary trunk result in malperfusion of the left ventricular myo- cardium, with the right coronary artery becoming large and tortuous. Previous existence or the rapid develop- ment of collateral vessels between the right and the left coronary arteries may prevent ischemia. To the best of our knowledge, our patient is one of the oldest reported cases in the literature. Our patient’s lack of symptoms until presentation may be related to extensive collateral vessels between the left and right coronary arteries, which provided enough oxygenated blood to her myo- cardium. But, the cause-effect relationship between ALCAPA and ventricular fibrillation in this elderly patient cannot be definitely proved. Surgery is considered the treatment of choice for this anomaly. Various surgical methods have been attempted, including simple ligation, bypass grafts and reimplantation of coronary arteries in the aorta [5]. Considering our patient’s old age and her family request she was discharged home on medication including acet- ylsalicylic acid, amiodarone and losartan. Conclusion In this article we describe an elderly woman presenting with ventricular fibrillation, who was found to have a coronary anomaly. To the best of our knowledge the patient in this case is one of the oldest, or may be the oldest, patient with this type of coronary anomaly, known as ALCAPA syndrome, who survived up to 85 years of age. It behooves one to consider coronary anomaly as a possible cause of sudden death even in an octogenarian. Consent Written informed consent was obtained from the patient for publication of this case report and any accompany- ing images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Additional material Additional file 1: Selective right coronary angiography at anteroposterior (AP) view reveals a single large right coronary artery with retrograde filling of the left anterior descending artery (LAD), left circumflex artery (LCX), Left Main (LM) and pulmonary artery(PA). Authors’ contributions PA resuscitated our patient and stabilized our patient’s clinical status. AS performed the coronary angiography and confirmed the diagnosis. Both authors read and approved the final manuscript.