Establishing a two coronary system is the best treatment option for anomalous origin of left coronary artery from the pulmonary artery (ALCAPA). We describe a case of ALCAPA with three decades of follow up after an end-to-end anastomosis of left subclavian artery and left coronary artery with mitral valve replacement. This technique of establishing a two coronary system was done in an era when coronary transfer technique was not established and myocardial protection techniques were not available. This case is also the longest follow up of prosthetic mitral valve replacement in a child with ALCAPA.
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