Angiogram: ALCAPA, but with a twist!

It is ALCAPA alright. But, look at the still frame below. There is a coronary artery originating from the aortic root as well! You will see it when you see the angiogram again. Needs more views to solve this.

Okay, this is not a standard case. Normally-arising vessel from left coronary sinus of aorta was mainly LCX with a rudimentary LAD. The one arising from PA, was supplying major part of LV. We mulled over what to do with this patient. Finally, she had a CABG to LCA from PA with ligation of origin of LCA from PA. Reimplanting this to aortic root is another option.