LAUSR

Case summary We report a 2-year-old female infant admitted to our institution because of a fever and severe cough. The patient was previously diagnosed with dilated cardiomyopathy in another hospital and treated with medication. The physical examination revealed severe dyspnea with obvious retraction signs of the three fossa. The patient’s blood pressure was 88/60 mmHg, respiration rate was 44 per minute, and pulse rate was 122 bpm. The patient’s chest X-ray showed patchy bilateral localized cloudy opacity and a significantly enlarged heart shadow. The ECG delineated ST-T segment changes in leads V1 to V4. The echocardiography and computed tomography angiography (CTA) demonstrated an anomalous origin of the left main coronary artery (LCA) from the pulmonary artery (ALCAPA), anomalous aortic origin of the right coronary artery (RCA) from the left coronary sinus, and origin of the posterior descending coronary artery from the RCA.