Anomalous origin of the left coronary artery from the pulmonary artery with bileaflet mitral valve prolapse is rare and seldom reported. We report a case of an elderly man who presented with typical angina symptom and a positive exercise stress test. Coronary angiogram failed to identify arterial course due to the presence of extensive collaterals. Images from cardiac computed tomography angiography provided the correct diagnosis and guided treatment. He was treated with medical therapy and remained asymptomatic on follow-up.

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