ALCAPA and ASD Secundum Unmasked by Severe Postpartum Haemorrhage Complicated by Heart Failure.

Abnormal Left Coronary Artery from Pulmonary Artery (ALCAPA) is a rare congenital coronary anomaly in which the left main coronary artery arises from the pulmonary trunk, resulting in a left to right shunt. ALCAPA is associated with septal defects and patent ductus arteriosus. The case discussed had a secundum atrial septal defect. Sudden cardiac death is a feared complication. We discuss the hemodynamics of this shunt combination and outline its management, emphasizing shunt hemodynamics during pregnancy. This case highlights that pregnant patients with ALCAPA are at high risk and require optimal peri- and postpartum care. After surgical establishment of dual coronary circulation, patients have carried subsequent pregnancies to term.