Anomalous origin of left coronary artery from pulmonary artery (ALCAPA) is a rare congenital cardiovascular anomaly. The mortality rate among infants and children without operation has been eighty to ninety-five percents and few patients survive till teen-age or adulthood. This anomaly was detected during elective coronary angiogram in a 32 year-old female patient with atypical chest pain. Reversible ischemia was demonstrated on myocardial 201Tl-SPECT. Coronary angiogram revealed anomalous origin of left coronary artery from pulmonary artery.