Adult-type ALCAPA: missed at preoperative evaluation

The Bland-White-Garland syndrome, or Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) syndrome, is a rare congenital cardiac anomaly often associated with high mortality, if left untreated. We present a case of a 43-year-old female with undiagnosed ALCAPA who initially underwent mitral valve surgery for severe mitral regurgitation, only to require reoperation due to adult-type ALCAPA. Intraoperatively, the discovery of dilated right coronary artery and its branches and absence of the left coronary ostium prompted further investigation, leading to the diagnosis of adult-type ALCAPA. Surgical correction remains the definitive treatment, with various techniques available depending on patient age and anatomical considerations. In this case, a modified Cabrol graft was successfully employed due to anatomical constraints.