Anomalous origin of the left coronary artery from the pulmonary artery is a rare lesion. Untreated, up to 90% of patients die before 1 year of age. The Takeuchi operation and direct coronary artery reimplantation have resulted in low mortality rates and excellent functional outcome. We present the case of a 6-year-old girl with impaired exercise tolerance in whom anomalous origin of the left coronary artery from the pulmonary artery was detected. A Takeuchi operation was performed. Routine follow-up was successfully done by echocardiography. The postoperative anatomy was visualized in detail, including a baffle-to-pulmonary artery fistula and a coronary artery stenosis. Potentially, given current echocardiographic technology in the hands of experienced operators, routine follow-up may be done noninvasively, leaving angiography for nonroutine indications.