Successful Takeuchi Repair in a 48-Year-Old Woman With ALCAPA

BACKGROUND: Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly, with high mortality if untreated. In adult-type ALCAPA, the risk of subclinical ischemia and sudden cardiac death persists. Surgical correction is generally recommended, yet the optimal surgical approach in adults remains debated.

CASE SUMMARY: A 48-year-old woman presented with exertional angina. Imaging revealed ALCAPA, with the left coronary artery arising from the nonfacing sinus of the pulmonary artery. Given the anatomical challenge of direct reimplantation and the patient's young age, Takeuchi repair was performed. Postoperative recovery was uneventful, with restored dual coronary circulation and normal ventricular function.

DISCUSSION: Although direct coronary reimplantation is the preferred treatment in children, it may be technically difficult in adults. Takeuchi repair offers an option in anatomically unfavorable cases, though it carries a risk of late complications.

CONCLUSIONS: In anatomically complex adult ALCAPA cases, Takeuchi repair is a valuable alternative to direct reimplantation or coronary artery bypass grafting. Careful long-term follow-up remains essential.