Anomalous origin of the left coronary artery fromthe pulmonary artery (ALCAPA) is an extremelyrare and fatal, but a treatable congenital anomaly ofthe coronary circulation. ALCAPA usually presents
as myocardial ischemia, cardiomegaly and heartfailure in infancy. About 90% of the infants diewithin the first year of life, if left untreated. Timely
diagnosis by echocardiography and coronarycomputed tomography angiography with surgicalcorrection is life-saving. Herein, we report a sixmonth-old infant with ALCAPA who presented with dilated cardiomyopathy, congestive cardiac failure and failure to thrive. The patient underwent surgical correction for the same but succumbed to
the refractory congestive cardiac failure. All infants who present with cardiomegaly and congestive cardiac failure with electrocardiographic (ECG) changes suggestive of myocardial ischemia, should
be evaluated for ALCAPA syndrome.

Keywords: ALCAPA; anomalous origin of the coronary arteries; Bland-White-Garland syndrome; congenital heart disease; dilated cardiomyopathy; echocardiography; heart failure.