{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T10:29:59Z","timestamp":1787567399028,"version":"build-2736575974"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Anomalous left coronary artery from the pulmonary artery (ALCAPA), also known as Bland-White-Garland syndrome, is a rare congenital coronary artery anomaly with an incidence of approximately 1 in 300,000 live births, accounting for 0.25%\u20130.5% of all congenital heart diseases. Without surgical correction, approximately 90% of affected infants die within the first year of life due to myocardial\u00a0ischemia and heart failure. However, a small subset of patients with well-developed collateral circulation\u00a0may survive into adulthood without marked symptoms. We report an incidentally diagnosed case of ALCAPA\u00a0in a 76-year-old man who was admitted for benign prostatic hyperplasia and urinary retention and underwent cardiovascular evaluation before non-cardiac surgery. Electrocardiography showed sinus bradycardia and complete right bundle branch block, and ambulatory celectrocardiography documented\u00a0frequent supraventricular premature beats and short\u00a0supraventricular\u00a0tachycardia runs without significant\u00a0ST-T abnormalities. Echocardiography showed a dilated right coronary artery, a suspected coronary fistula, mild chamber enlargement, preserved left ventricular systolic function, and no typical resting segmental wall-motion abnormality. Coronary CT angiography (CTA), performed after cardiology consultation, demonstrated the left main coronary artery arising from the pulmonary trunk, a markedly dilated and tortuous right coronary artery, extensive collateral circulation among the right coronary artery, left coronary system, and bronchial arteries, and a high coronary artery calcium score of 941.74 Agatston units. Cardiac enzymes were not elevated, but formal stress testing and cardiac magnetic resonance imaging were not performed during the index admission. The management decision was therefore framed as individualized conservative follow-up rather than evidence that conservative treatment is generally safe in adult ALCAPA. This case illustrates the diagnostic value of CTA for defining coronary anatomy in late adult ALCAPA, the need for functional ischemia and scar assessment when feasible, and the therapeutic tension between guideline-based surgical recommendations and individualized decision-making in elderly patients with preserved resting ventricular function.<\/jats:p>","DOI":"10.3389\/fcvm.2026.1905385","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:10:35Z","timestamp":1787562635000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidentally diagnosed anomalous left coronary artery from the pulmonary artery in a 76-year-old man undergoing preoperative evaluation: a case report and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Guoao","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Radiology, Nanchuan Hospital of Traditional Chinese Medicine","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirui","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Radiology, Nanchuan Hospital of Traditional Chinese Medicine","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zihua","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Radiology, Nanchuan Hospital of Traditional Chinese Medicine","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1007\/s00247-007-0544-8","article-title":"Bland-White-Garland syndrome of anomalous left coronary artery arising from the pulmonary artery (ALCAPA): a historical review","volume":"37","author":"Cowles","year":"2007","journal-title":"Pediatr Radiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1136\/hrt.21.2.149","article-title":"The anomalous origin of the left coronary artery from the pulmonary artery","volume":"21","author":"Keith","year":"1959","journal-title":"Br Heart J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1148\/rg.292085059","article-title":"ALCAPA syndrome: not just a pediatric disease","volume":"29","author":"Pe\u00f1a","year":"2009","journal-title":"Radiographics"},{"key":"B4","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1002\/clc.20848","article-title":"Anomalous origin of the left coronary artery from the pulmonary artery in adults: a comprehensive review of 151 adult cases and a new diagnosis in a 53-year-old woman","volume":"34","author":"Yau","year":"2011","journal-title":"Clin Cardiol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1111\/jocs.15238","article-title":"Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in adults: collateral circulation does not preclude direct reimplantation","volume":"36","author":"Cavalcanti","year":"2021","journal-title":"J Card Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.jccase.2017.04.006","article-title":"An adult case of Bland-White-Garland syndrome with collaterals from giant right coronary artery and bronchial artery","volume":"16","author":"Tobita","year":"2017","journal-title":"J Cardiol Cases"},{"key":"B7","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1016\/j.hrtlng.2014.06.048","article-title":"Surviving sudden cardiac death secondary to anomalous left coronary artery from the pulmonary artery: a case report and literature review","volume":"43","author":"Alsara","year":"2014","journal-title":"Heart Lung"},{"key":"B8","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1186\/s13019-024-02906-5","article-title":"From asymptomatic adult patient to cardiopulmonary resuscitation - treatment of ALCAPA with total arterial myocardial revascularisation and mitral valve repair","volume":"19","author":"Al-Obaidi","year":"2024","journal-title":"J Cardiothorac Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1055\/s-0042-119452","article-title":"Coronary artery anomalies: diagnosis and classification based on cardiac CT and MRI (CMR) - from ALCAPA to anomalies of termination","volume":"189","author":"Heermann","year":"2017","journal-title":"Rofo"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.11817\/j.issn.1672-7347.2023.230059","article-title":"Clinical manifestations and computed tomography angiography features of anomalous left coronary artery from the pulmonary artery syndrome","volume":"48","author":"Fan","year":"2023","journal-title":"Zhong Nan Da Xue Xue Bao Yi Xue Ban"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e698","DOI":"10.1161\/CIR.0000000000000603","article-title":"2018 AHA\/ACC guideline for the management of adults with congenital heart disease: a report of the American college of cardiology\/American heart association task force on clinical practice guidelines","volume":"139","author":"Stout","year":"2019","journal-title":"Circulation"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2805","DOI":"10.1093\/eurheartj\/ehad327","article-title":"Coronary steal: how many thieves are out there?","volume":"44","author":"Achim","year":"2023","journal-title":"Eur Heart J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/ehjcr\/ytaa257","article-title":"Case report of asymptomatic very late presentation of ALCAPA syndrome: review of the literature since pathophysiology until treatment","volume":"4","author":"Cambronero-Cortinas","year":"2020","journal-title":"Eur Heart J Case Rep"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1672","DOI":"10.1093\/eurheartj\/ehl497","article-title":"Bland-White-Garland syndrome: extensive collaterals prevent ischaemia","volume":"28","author":"Ercin","year":"2007","journal-title":"Eur Heart J"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1111\/echo.13807","article-title":"Adult presentation of ALCAPA: echo and CT diagnosis","volume":"35","author":"Kerut","year":"2018","journal-title":"Echocardiography"},{"key":"B16","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.jccase.2024.05.006","article-title":"A case of \u201clate adult type\u201d of ALCAPA syndrome in a 76-year-old woman","volume":"30","author":"De Stefano","year":"2024","journal-title":"J Cardiol Cases"},{"key":"B17","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1186\/s13256-018-1851-4","article-title":"An unusual presentation of anomalous left coronary artery from the pulmonary artery (ALCAPA) syndrome in a 70-year-old man: a case report","volume":"12","author":"Vizzuso","year":"2018","journal-title":"J Med Case Rep"},{"key":"B18","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1016\/0002-8703(83)90207-7","article-title":"Anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland syndrome) in adult patients: long-term follow-up after surgery","volume":"106","author":"Moodie","year":"1983","journal-title":"Am Heart J"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1016\/j.athoracsur.2014.12.035","article-title":"Outcomes of anomalous left coronary artery from pulmonary artery repair: beyond normal function","volume":"99","author":"Cabrera","year":"2015","journal-title":"Ann Thorac Surg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"30234","DOI":"10.1053\/j.semtcvs.2017.08.018","article-title":"Anomalous origin of the left coronary artery from the pulmonary artery presenting in adulthood: a French nationwide retrospective study","author":"Le Berre","year":"2017","journal-title":"Semin Thorac Cardiovasc Surg"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1905385\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:10:37Z","timestamp":1787562637000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1905385\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":20,"alternative-id":["10.3389\/fcvm.2026.1905385"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1905385","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"article-number":"1905385"}}