The Takeuchi procedure was successfully performed in a 31-year-old female with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). The internal tunnel in the main pulmonary trunk was patient in coronary angiography and a marked improvement of coronary perfusion was demonstrated with a single photon emission CT four months after surgery. Cardiac catheterization at that time revealed mild supravalvular pulmonary stenosis with no clinical manifestation. The Takeuchi procedure may be the treatment of choice even for adults with ALCAPA if it is arising from the posterior wall of the pulmonary trunk, since a long-term patency is expected in this procedure than in coronary artery bypass grafting.