ALCAPA and CAF as Congenital Coronary Artery Anomalies in Two Children: Two case reports.

Introduction: Congenital coronary artery anomalies (CCAAs) represent the second most common cause of sudden cardiac death among young athletes. Their clinical import relates mainly to the resultant probable myocardial ischemia. Many CCAAs have minimal impact on myocardial perfusion, and thus, patients may remain asymptomatic as is the case in congenital coronary artery fistula. However, other anomalies such as anomalous origin of the left coronary artery from the pulmonary artery may be symptomatic as they significantly affect blood flow to the heart muscle.

Case Presentation: We present two cases of surgical repair of ALCAPA in a 5-year-old girl, and right coronary artery fistula to the right ventricle in a 9-year-old boy.

Discussion: CCAA are anomalies that can be asymptomatic or symptomatic. Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) often requires prompt surgical intervention, even if asymptomatic, with the preferred method of reimplantation of the anomalous left coronary artery (LCA) into the aorta. This significantly improves heart function. Coronary artery fistula (CAF) is a rare congenital defect that often originates from the right coronary artery (RCA) and predominantly drains into the right heart structures. Most CAFs in asymptomatic children can be left untreated, but some recommend early closure to avoid severe complications.

Conclusion: CCAAs are rare congenital heart defects, but early diagnosis and surgical intervention are critical in cases like ALCAPA to prevent serious outcomes. Surgical repair of isolated CAF can also lead to excellent outcomes.