The left coronary artery originates from the pulmonary artery (ALCAPA) also known as bland-white-garland syndrome is a rare congenital abnormality first reported by Brooks in 1886.  Approximately 1 in 300,000 live births.  The patient had no special discomfort in his childhood and young adulthood, but gradually presented with dyspnea, angina pectoris, syncope and other clinical symptoms as he grew older. Symptoms of ALCAPA are usually associated with myocardial ischemia. The lateral branch of the right coronary artery usually forms when pulmonary resistance drops and supplies blood to the left coronary artery to satisfy the oxygen consumption of the myocardium. If the pulmonary artery perfusion pressure is reduced, blood flow in the left coronary artery will enter the pulmonary artery which called " steal blood "phenomenon, leading to ischemia and hypoxia in left ventricular. Large shunts from left to right often result in chronic ischemia, even with adequate collateral circulation.
In many cases, the anterolateral papillary muscle may contract due to scarring and calcification from chronic ischemia, a process that may lead to mitral regurgitation.  Mitral valve replacement may be considered in patients with severe mitral valve prolapse. The second patient had mitral regurgitation, which was considered to be related to papillary muscle ischemia. After mitral valve replacement + left main stem ligation + coronary artery bypass graft, the patient's heart failure symptoms were significantly improved during a 3-year follow-up.
According to whether there is abundant collateral circulation between the left and right coronary arteries, the disease can be divided into infantile type and adult type. Because the pressure and oxygen saturation of the aorta and pulmonary artery in the fetus are equal, there are no obvious signs of disease during the fetus, and no collateral branches form during this time due to normal myocardial perfusion. However, after birth, pulmonary vascular resistance decreases and coronary artery theft occurs. The onset of symptoms depends on the number of collateral branches between the left and right coronary arteries and pulmonary artery pressure.  A review of ALCAPA patients showed that 66% of adult patients presented with angina, dyspnea, palpitations or fatigue. Ventricular arrhythmias, syncope, or sudden death occurred in 17% of patients, while 14% remained asymptomatic. 
Surgery and percutaneous closure are the main treatment methods for these patients. Surgical treatment includes :(1) ligation of the left main artery and reconstruction of the left coronary artery system with a vein or internal mammary artery graft (2) direct or indirect reimplantation of the left aorta to the aorta via a pulmonary artery or internal iliac artery graft. Ligation of the abnormal artery with coronary artery bypass grafting is the preferred method in adults, and reimplantation of the left main coronary artery into the aorta is the most common technique in the pediatric population. The main treatment for minimally invasive percutaneous treatment was percutaneous ALCAPA closure with amplazee vascular occluder. 
Imaging examination is crucial for the differential diagnosis of ALCAPA patients. Early diagnosis combined with necessary surgical treatment can significantly improve the prognosis of these patients.