Anomalous Left Coronary Artery Originating From the Pulmonary Artery Diagnosed in an Adult

• ALCAPA presenting in adulthood is a rare cause of ischemic cardiomyopathy. • An unexplained dilated RCA should raise concern for ALCAPA. • Multimodality imaging is helpful for diagnosis, but often echo alone can be diagnostic. • Treatment is reimplantation of the LMCA.