We report a case of Bland-White-Garland syndrome with advanced age. The patient, a 67-year-oldwomen, presented with a history of congestive heart failure. Coronary catheterization revealed ananomalous origin of the left coronary artery （LCA） from the trunk of the pulmonary artery and hugeright coronary aneurysm.Myocardial single photon emission computed tomography （SPECT） showed previous myocardialinfarction with reversible ischemia in left anterior descending（ LAD） region.We performed LCA direct closure and coronary artery bypass graft. The patient recovered uneventfullywithout signs of ischemia. Although a bypass graft was patent, left ventricular function had notbeen improved immediately probably due to the coronary flow pattern changes.