The case of a 6-week-old girl with left coronary artery originating from the pulmonary artery (Bland-White-Garland syndrome) is reported. Therapy consisted of a subclavian-coronary artery anastomosis via left anterolateral thoracotomy extended by transverse sternotomy. This approach allowed both the easy dissection of the left subclavian artery and the use of extracorporeal circulation while doing the anastomosis. Operation and postoperative course were uneventful. Angiography after one year revealed a patent anastomosis and a totally recovered left-ventricular function.