Abstract:
ALCAPA Syndrome: A Case of Failure to Thrive and Feeding difficulty in a 3-Month-Old Infant.
Background: Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) also known as Bland-White-Garland syndrome, is a rare congenital cardiac anomaly occurring in approximately 1 in 300,000 live births with potentially life-threatening consequences, this is a very severe condition with a 90% mortality rate in the first year of life without treatment. ALCAPA is often presented in infancy or early childhood. It results in myocardial ischemia due to inadequate coronary circulation, which may progress to heart failure if left untreated. Early recognition and intervention are vital to prevent severe complications. This case report highlights the clinical presentation, diagnostic challenges, and successful management of ALCAPA syndrome in a 3-month-old infant.
Case Presentation: A 3-month-old female infant presented to the emergency room with a history of failure to thrive (FTT), persistent sweating during feeding, and irritability. On examination, the baby was found to have poor weight gain, and diaphoresis while feeding. The heart murmur was noted on auscultation, and further investigation was initiated. Echocardiography revealed signs of left ventricular dysfunction and coronary artery abnormalities. CT angiography confirmed the diagnosis of ALCAPA, showing that the left coronary artery originated from the pulmonary artery.
Management and Intervention: The patient was promptly referred for surgical intervention. Coronary artery reimplantation was successfully performed, and postoperative recovery was uneventful. Following surgery, the patient showed marked improvement in left ventricular function and symptom resolution.
Discussion: ALCAPA can often present with nonspecific symptoms, making it a challenging diagnosis in young infants. The classic presentation of failure to thrive, and sweating during feeding, should prompt consideration of congenital heart disease. Early recognition and timely surgical intervention are critical to prevent irreversible myocardial damage and optimize long-term outcomes. This case emphasizes the importance of a high index of suspicion in children with unexplained heart failure or murmurs, as early intervention significantly improves prognosis.
Conclusion: ALCAPA syndrome should be included in the differential diagnosis of infants with failure to thrive, sweating during feeding, and other signs of heart failure. Timely diagnosis through advanced imaging techniques like CT angiography and prompt surgical treatment can lead to significant clinical improvement and a favorable prognosis.
