Bland-White-Garland syndrome (BWG) is a rare congenital anomaly that is predominantly discovered in infancy. BWG is characterized by an anomalous origin of the left coronary trunk from the pulmonary artery that produces a coronary steal phenomenon, left-to-right shunt, and thus an abnormal left ventricular perfusion. The latter may induce myocardial necrosis, left ventricular dysfunction and commonly associated with mitral regurgitation. Despite its high mortality without surgical repair in infancy, several cases were reported to reach adulthood. In some patients, however, BWG was revealed only in older age, and may cause mild symptoms. Recent developments in cardiovascular MRI enable the determination of heart function, viability and perfusion with high resolution. We present three middle-aged female BWG cases indicating that MRI studies may give further insight into the therapeutic decision making in this age-group.