anomalous origin of the left main coronary artery from the pulmonary artery ( alcapa ) is a rare but serious congenital anomaly that occurs in 0.5% of children with congenital heart disease . it may result from abnormal formation of the conotruncus or from persistence of pulmonary buds together with involution of the aortic buds that eventually form the coronary arteries . it predominantly presents in the first year of life , resulting in left ventricular ischemia and dysfunction . if uncorrected , the condition carries a very poor prognosis . owing to the development of extensive collateral circulation , only a very small percentage of patients survive to adulthood , where various manifestations of myocardial ischemia ( such as left ventricular dysfunction and mitral regurgitation ) are usually present . the management and longer - term outcomes have not been adequately defined , but anatomical surgical correction remains the best treatment modality for this subset of patients . a 17 year - old male patient presented with sudden cardiac death ( scd ) while playing football and was successfully resuscitated . electrocardiography revealed sinus rhythm and signs of left ventricular hypertrophy , without pathological q waves . two - dimensional color flow doppler echocardiography revealed mildly dilated left ventricular dimensions with borderline global systolic function ( ejection fraction =  50% ) and mild mitral regurgitation ( mr ) . the left main coronary artery ( lmca ) was arising from the non - facing sinus of the pulmonary artery with flow reversal . multi - slice computed tomography ( msct ) confirmed the diagnosis and the exact location of the orifice and proximal course of the anomalous coronary artery ( fig . the condition was surgically corrected by harvesting the button of anomalous left main coronary ostium with the surrounding wall of the non - facing sinus of the pulmonary artery , mobilizing the button with the left main coronary artery and reimplanting them in the anatomical position within the left sinus of valsalva . the postoperative course was smooth and the patient was discharged on the fifth postoperative day . pre - discharge msct coronary angiography revealed a smooth takeoff of the lmca from the aorta with no obstruction ( fig . six months later , the patient was completely asymptomatic and had returned to his normal daily activities . follow up echocardiography showed significant reverse remodeling with normal lv dimensions and ejection fraction , and no mitral regurgitation . cardiac magnetic resonance imaging revealed mild subendocardial fibrosis in the basal and mid anteroseptal wall . while cardiomyopathies and channelopathies are responsible for the vast majority of scd in young adults , coronary artery anomalies including alcapa should always be included in the differential diagnosis and workup of survivors . albeit rare , it is important to remember that scd may be the first presentation in the latter group . in the absence of widespread myocardial scarring , anatomic correction helps restore left ventricular function and myocardial perfusion , thus eliminating the substrate for further arrhythmias / scd .
we report on a young adult with alcapa , who was successfully resuscitated after collapsing in ventricular fibrillation while playing football . 
 this was followed by anatomical correction of the anomaly with a smooth recovery and return to his daily activities . 
 the advantages of this approach are discussed in this brief report .