Author: Sana Ullah, MB ChB, FRCA – Children’s Medical Center, Dallas TX


A 4-month-old infant with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), severe mitral regurgitation, and a dilated left ventricle with severely diminished ventricular function is admitted to the cardiac ICU in severe congestive heart failure. The mitral valve papillary muscles are noted to be echo-bright. In patients with ALCAPA, which of the following co-existing lesions is MOST LIKELY to be associated with a less severe degree of myocardial ischemia?