Anomalous Left Coronary Artery Arising from the Pulmonary Artery (ALCAPA): The Critically Important Role of Color Flow Doppler in Identifying a Rare Intramural Course.

• ALCAPA must be considered in an infant with ischemia and/or heart failure. • A rare variant with intramural aortic course may appear normal on 2D echo. • Retrograde color flow in the LCA is highly suspicious for this lesion. • Ambiguous cases will benefit from multimodality imaging via catheterization or CT. • Early recognition may lead to lifesaving surgical correction.