When anomalous left coronary artery from the pulmonary artery is diagnosed in infancy, it is associated with high mortality, but collaterals permit rare adult survival despite coronary steal. We report normalisation of perfusion abnormality after transcatheter proximal left coronary occlusion in a symptomatic adult with inducible ischaemia.

A forty-eight-year-old female presented with exertional chest pain; EKG showed sinus rhythm with left axis deviation with intraventricular conduction defect. Echocardiogram diagnosed an anomalous left coronary artery arising from the pulmonary artery with normal ventricular function which was further confirmed by CT. The case was discussed with the surgical team, and it was decided to surgically ligate. The patient did not give consent for the surgical procedure; the patient was taken up for the procedure.

Device was released safely after confirming the position on echocardiogram after the procedure showed improvement in intraventricular conduction defect and QTc duration, and also no significant ischaemic changes were noted. Myocardial perfusion scintigraphy was done after 6 months of procedure which showed improvement in contractile function and perfusion of left ventricle.

Device closure in long-standing anomalous left coronary artery from pulmonary artery case is safe, and long-term follow-up is needed.