ALCAPA – a need for guidelines for managing the adult type

a 15-year old boy was referred to a university Hospital, for investigation of a recently en passant discovered heart murmur. He felt completely healthy, was a member of the local icehockey team and was playing at least 5 times a week without any symptoms. physical findings consisted of a physically fit young man with normal breathing, normal heart rate and normal blood pressure. The only abnormal finding was a harsh systodiastolic murmur grade III/IV, localized at the left sternal boarder and in the apex region, but not heard on the back. Figure 1a: apical 4-chamber view showing multiple, predominantly diastolic, abnormal septal color flows indicating septal perforator coronary arteries.