Congenital left main coronary artery (LMCA) atresia is a rare anomaly and surgical revascularization is recommended once the diagnosis is confirmed. In some cases, LMCA atresia will coexist with other cardiac anomalies, mostly in pediatric patients. A 32-year-old woman had congenital LMCA atresia associated with patent ductus arteriosus (PDA), aortic regurgitation (AR), and moderate pulmonary hypertension. The PDA and AR were repaired surgically and the patient's symptoms improved. Coronary revascularization was not performed because the LCA was supplied by 2 large conus arteries, as "naturally occurring" bypass arteries. The patient remained asymptomatic at the 2.5-year follow-up visit. Given the positive outcome in this patient, surgical repair of the associated cardiac defect without coronary revascularization may be a reasonable approach for patients with congenital LMCA atresia, in which the left coronary arterial tree is supplied by other "naturally occurring" bypass arteries.