We report a case of anomalous origin of left anterior descending coron
ary artery in a patient with tetralogy of Fallot, absent pulmonary val
ve cusps, and origin of left pulmonary artery from the ascending aorta
. Pulmonary outflow tract obstruction was successfully treated by dire
ct anastomosis of the main pulmonary artery to the right ventricle. Th
is approach prevented injury to the anomalous coronary artery and avoi
ded the use of an extracardiac conduit.