Background: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect that has serious challenges from diagnostic, surgical, to postoperative management. Case description: We report a 16-month-old patient, who underwent ALCAPA repair in our center. This patient came to the hospital with severe heart failure symptoms such as shortness of breath, cough and failure to thrive. Decreased left ventricle function and severe mitral valve regurgitation due to left ventricle dilatation was found. In this case, the left main artery (LMA) was not found and there were two ostial of the left anterior descending artery and circumfl ex artery on the pulmonary artery; we managed the coronary artery transfer by using 4-mm pericardial roll extension. No mechanical assist device was needed. Long-term follow-up of the patient (7 years) showed that the patient survived and had a class I Ross Heart Failure Classifi cation. Follow-up echocardiography revealed improvement of left ventricular ejection fraction and mitral valve regurgitation. Conclusion: ALCAPA repair is still a challenging procedure but has an excellent opportunity to improve the quality of life of the patient. Pericardial roll graft could be an optional procedure for ALCAPA repair to restore the dual coronary artery system. © 2022 Czech Society of Cardiology Z.S. All rights reserved.