Anomalous origin of the left coronary artery from the right pulmonary artery associated with complex congenital heart disease

The rare coexistence of anomalous origin of the left coronary artery from the main pulmonary artery with other cardiac malformations prompts us to report an unusual case of anomalous origin of the left coronary artery from the right pulmonary artery associated with complete atrioventricular canal, patent ductus arteriosus, and coarctation of the aorta. It is important to recognize the presence of an anomalous origin of the left coronary artery in complex congenital heart disease since the coronary artery anomaly will increase the morbidity of the associated congenital cardiac malformation. Conversely, correction of the associated congenital cardiac defect may decrease the pulmonary artery pressure resulting in reduced left coronary artery flow, myocardial ischemia, and death.