Infantile Heart Failure, Exotic Diagnosis but Dismal Prognosis

Infantile heart failure, though most ofen due to idiopathic dilated cardiomyopathy or viral myocarditis, it could be due to plethora of causes like endomyocardial fibrosis, large shunt lesions,ventricular outflow tract obstruction, Kawasaki disease, genetic abnormality, rhabdomyolysis or ALCAPA. Anomalous origin of left coronary artery from pulmonary artery (ALCAPA) is a rare congenital coronary anomaly which can lead to ischemic dilated cardiomyopathy with very high morbidity and mortality in infancy. In infants, it manifests as congestive cardiac failure and survivalinto adulthood is rare. The diagnosis can be reliably made by typical electrocardiogram and echocardiography findings. Our patient presented with gradually worsening of heart failure since 1month of age. She was evaluated elsewhere as idiopathic dilated cardiomyopathy.Her electrocardiogram (ECG) showed typical pathological Q waves inateral leads and echocardiography (ECHO) showed characteristic dilated chambers with regional wall motion abnormalities, mild mitral regurgitation, extensive intramyocardial collaterals and anomalous origin of left coronary artery from pulmonary artery. She was given symptomatic treatment and offered definitive surgery.