A surreal illustration of a woman with a glowing heart, symbolizing resilience in the face of a rare heart condition.

Living with a Heart Anomaly: A 67-Year-Old's Unexpected Discovery

Kai Mendoza in Health & Wellness August 2025 • 4 min read.

"Uncommon Survival: Exploring the Case of a Woman Living Decades with ALCAPA"

In the realm of medical anomalies, certain conditions defy expectations, challenging our understanding of the human body's resilience. Anomalous left coronary artery from the pulmonary artery (ALCAPA), a rare congenital heart defect, typically surfaces in infancy or childhood, often with severe consequences. This condition, where the left coronary artery originates from the pulmonary artery instead of the aorta, deprives the heart muscle of oxygen-rich blood, leading to ischemia and potential heart failure.

Historically, ALCAPA carries a grim prognosis, with a 90% mortality rate in untreated children. Survival beyond infancy often hinges on the development of collateral circulation – alternative pathways that reroute blood flow to compensate for the missing connection. However, even with these compensatory mechanisms, most individuals succumb to the condition by their mid-30s.

Against this backdrop of medical understanding comes a truly remarkable case: a 67-year-old woman diagnosed with ALCAPA. Her story compels us to re-evaluate our understanding of this condition, its long-term implications, and the potential for survival and adaptation.

A Lifelong Anomaly: The Patient's Story

A surreal illustration of a woman with a glowing heart, symbolizing resilience in the face of a rare heart condition.

Our patient's journey began in childhood, marked by episodes of unexplained dyspnea (shortness of breath). Despite undergoing three surgeries under general anesthesia, these symptoms remained a mystery, never fully investigated. It wasn't until the age of 67, during an evaluation for atypical chest pain, that the underlying cause was revealed: ALCAPA.

Diagnostic testing, including a transthoracic echocardiogram, revealed moderate left ventricular hypertrophy (enlargement of the heart muscle) and mild mitral regurgitation (leakage of the mitral valve). Notably, color flow mapping revealed significant intercoronary collateral circulation, highlighting the body's remarkable ability to compensate for the abnormal connection. Coronary angiography confirmed the diagnosis, showing a dilated right coronary artery supplying the left coronary artery through these collateral vessels, with runoff into the pulmonary artery.

Key findings from the patient's case:

Diagnosis of ALCAPA at age 67.
History of unexplained dyspnea in childhood.
Significant intercoronary collateral circulation.
Refusal of surgical intervention.

Faced with the diagnosis, the patient was presented with the option of surgical correction. However, after careful consideration, she declined intervention, opting instead for medical management. This decision, while unconventional, underscores the complexities of treating adult patients with congenital heart defects, where the risks and benefits of surgery must be carefully weighed against the patient's overall health and preferences.

Atypical Cases and Rethinking Treatment

This case serves as a powerful reminder that medical conditions do not always follow predictable patterns. While surgical correction remains the gold standard for ALCAPA, the patient's stable condition under medical management challenges this conventional wisdom. It emphasizes the need for individualized treatment plans, taking into account the patient's age, overall health, symptom severity, and personal preferences. Further research is needed to understand the long-term outcomes of medically managed ALCAPA in adults, particularly those with well-developed collateral circulation. This information will be crucial in guiding clinical decision-making and improving the lives of individuals living with this rare and often life-threatening condition.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1177/2150135118772834, Alternate LINK

Title: Abnormal Origin Of The Left Coronary Artery From The Pulmonary Artery Discovered At Age 67: What To Do?

Subject: Cardiology and Cardiovascular Medicine

Journal: World Journal for Pediatric and Congenital Heart Surgery

Publisher: SAGE Publications

Authors: Fadoua Lachhab, Rachida Amri, Loubna Mahfoudi, Said Moughil

Published: 2018-10-18

Everything You Need To Know

What is ALCAPA, and why is it considered a significant medical anomaly?

ALCAPA, or Anomalous Left Coronary Artery from the Pulmonary Artery, is a rare congenital heart defect where the left coronary artery originates from the pulmonary artery instead of the aorta. This deprives the heart muscle of oxygen-rich blood, potentially leading to ischemia and heart failure. The usual prognosis for untreated ALCAPA is poor, especially in infancy and childhood where mortality rates are high. The fact that this woman was diagnosed at 67 underscores that some individuals may survive due to collateral circulation, which creates alternative pathways for blood flow.

What specific symptoms and diagnostic findings led to the discovery of ALCAPA in this 67-year-old woman?

In this specific case, the 67-year-old woman had a history of unexplained dyspnea (shortness of breath) since childhood. However, the diagnosis of ALCAPA wasn't made until she was 67 years old during an evaluation for atypical chest pain. Diagnostic testing revealed moderate left ventricular hypertrophy and mild mitral regurgitation. Most importantly, color flow mapping showed significant intercoronary collateral circulation, which was confirmed by coronary angiography showing a dilated right coronary artery supplying the left coronary artery, highlighting the body's capacity to compensate for the anomaly.

Why did the 67-year-old patient choose medical management over surgical correction for her ALCAPA diagnosis?

The woman chose medical management over surgical intervention after being diagnosed with ALCAPA at 67. While surgical correction is the standard treatment, her decision reflects the complexities of managing adult congenital heart defects, where the risks and benefits of surgery must be carefully balanced against the patient's overall health, age, and personal preferences. Her stable condition suggests that medical management can be a viable option, especially when there's well-developed collateral circulation. The fact that she was diagnosed at such a late age could also factor into her and her doctor's decisions.

What role does intercoronary collateral circulation play in the survival of individuals with ALCAPA?

Intercoronary collateral circulation refers to the development of alternative pathways for blood to flow between the coronary arteries. In the context of ALCAPA, it's a crucial compensatory mechanism that allows the heart muscle to receive blood from other sources when the left coronary artery is improperly connected to the pulmonary artery. The presence of significant intercoronary collateral circulation, as observed in the 67-year-old patient, is critical for survival and suggests that her body was able to adapt and maintain adequate blood supply to the heart despite the anomaly.

What are the implications of this case for rethinking treatment approaches to ALCAPA, particularly in adult patients?

This case emphasizes the need for individualized treatment plans for ALCAPA, especially in adults. Factors such as the patient's age, overall health, symptom severity, the extent of collateral circulation, and personal preferences should be considered. Further research is needed to understand the long-term outcomes of medically managed ALCAPA in adults with well-developed collateral circulation. Understanding these outcomes will help doctors make more informed decisions, refine treatment strategies, and improve the lives of individuals living with this rare condition.