A complex congenital cardiac defect was found in a 6 week old alpaca cria born in New York State. Echocardiogram revealed a large right atrium and large right ventricle, a single outflow tract positioned over the right ventricle, and a muscular ventricular septal defect. Necropsy findings revealed a double outlet right ventricle, a pseudotrouncus, a minimally patent ductus arteriosus, a hypoplastic left ventricle and no left atrium. Ventricular septal defects and persistent ductus arteriosus are the most common congenital defects in camelids. South American camelids evolved in high altitudes with low barometric pressure and they have unique adaptations to hypoxia, including profound peripheral vasoconstriction and cerebral hypometabolism. These adaptations may have contributed to six weeks of survival with the severe congenital cardiac defect seen in this cria. This case study highlights the cria’s clinical presentation, echocardiogram, and necropsy, followed by a discussion of camelid congenital cardiac defects and adaptations to hypoxia.