P>We report an adult patient with anomalous right pulmonary artery (RPA) from the ascending aorta with origin stenosis, a secundum type of atrial septal defect (ASD) with severe pulmonary arterial hypertension (PAH) in the left lung, and a protected right lung. Restoration of the continuity between the RPA and the left pulmonary arterial system was achieved without cardiopulmonary bypass. (J Card Surg 2011;26:201-204).