An adult case of anomalous origin of left coronary artery from pulmonary trunk was reported. The catheterization studies revealed significant amount of left to right shunt in the pulmonary trunk and anomalous origin of left coronary artery from pulmonary artery with well developed and marked tortuously dilated collaterals from the right coronary artery. During surgery, blood flow waveforms of the LAD was measured using pulsed Doppler velocimeter. After temporary closing of the origin of left coronary artery, blood flow of the LAD markedly decreased. A-C bypass grafting to LAD was performed successfully using saphenous vein and graft flow rate was 220 ml/min. These findings suggest that the coronary blood flow through the tortuously dilated collaterals after ligation of the origin of left coronary artery was insufficient to perfuse the left coronary artery.
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