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Background At present,creation of a dual coronary system with direct aortic implantation is the preferred management for anomalous origin of left coronary artery from the pulmonary artery (ALCAPA).However,controversy still exists over the initial management of mitral regurgitation (MR) at the time of ALCAPA repair.Methods Between March 2005 and March 2015,52 consecutive patients (20 males and 32 females) underwent direct aortic implantation of ALCAPA.Median age at surgery was 10 months (range,2 to 193).Mean weight was 9.7±7.8 kg.In order to facilitate the analysis,description of MR was given a numeric grade:0 =none,1 =trivial,2 =mild,2.5 =mild-moderate,3 =moderate,3.5 =moderate-severe,and 4 =severe.Resuits The LV shortening fraction (LVFS) demonstrated significant improvement between presentation and discharge (32.1±10.1％ vs.28.6±9.6％,P =0.023),and there was also significant improvement in the mean MR grade between presentation and discharge (2.40±1.16 vs.2.91±1.19,P =0.001).There were 4 hospital deaths (7.7％).The median follow-up was 21 months (range 1.5 to 111),3 patients (5.8％) were lost to follow-up,1 patient required reoperation for mitral valve replacement.Significant improvement was seen in LVFS between discharge and late follow-up (38.0±6.0％ vs.32.1±10.1％,P =0.001),however,the degree of MR did not demonstrate further change (2.29±1.20 vs.2.40±1.16,P =0.541).Conclusion Creation of a dual coronary system with direct aortic implantation of the left coronary artery results in complete recovery of left ventricular function.Concomitant mitral valve (MV) repair for ALCAPA patients with moderate-severe and severe MR is helpful to early MV function recovery.