Tetralogy of Fallot with anomalous LAD: repair without conduit.

We report a case of anomalous origin of left anterior descending coronary artery in a patient with tetralogy of Fallot, absent pulmonary valve cusps, and origin of left pulmonary artery from the ascending aorta. Pulmonary outflow tract obstruction was successfully treated by direct anastomosis of the main pulmonary artery to the right ventricle. This approach prevented injury to the anomalous coronary artery and avoided the use of an extracardiac conduit.